N^ 


/v 


UEFAF','  GF 
LLIEfTfE  GF  GG 

KVSforA.ffr; 


AjTEXT  BOOK 


OF 


The  Principles  of   Osteopathy 


BY 


GKDU  HULETT,  B.  S.,  D.  O. 

PROFESSOR  OF  PRINCIPLES  AND  PRACTICE  OF  OSTEOPATHY,  AMERICAN 

SCHOOL  OF  OSTEOPATHY;  MEMBER  OF  CLINICAL  STAFF  OF  THE 

SCHOOL  AND  STAFF  OF  PHYSICIANS  OF  THE  A.  T.  STILL 

INFIRMARY,  KIRKSVILLE,  MISSOURI. 


ILLUSTRATED. 


1903 

JOURNAL  PRINTING  COMPANY 
KIRKSVILLE,  MO. 


ti/XKMcVHS 


COPYRIGHT  1903 
BY  THE  AUTHOH. 


PREFACE. 


In  presenting  this  work  on  the  Principles  of  Osteopathy, 
the  author  is  aware  of  many  imperfections  both  in  thought 
and  arrangement  of  subjects;  yet  he  is  further  cognizant  of 
the  fact  that,  owing  to  the  dearth  of  satisfactory  literature  of 
the  nature  of  which  this  work  is  illustrative,  there  are  many 
in  the  student  ranks  as  well  as  in  the  field  who  will  welcome 
it  in  spite  of  its  many  faults.  It  must  be  understood  at  the 
outset  that  the  work  is  designed  primarily  for  the  student  who 
is  but  beginning  to  be  interested  in  the  new  method  of  heal- 
ing. Hence  to  those  who  are  already  practitioners  of  that 
method  the  matter  contained  in  the  following  pages  may  not 
seem  particularly  new  or  satisfying  in  the  way  of  suggesting 
ideas  of  an  immediately  practical  nature.  Yet  we  are  not 
without  hope  that  even  to  the  latter  class  there  are  many 
points  of  interest  which  will  help  to  throw  light  upon  some  of 
the  many  vexing  problems  that  continually  arise  in  the  ex- 
perience of  the  busy  practitioner. 

Neither  should  it  be  assumed  that  the  work  is  intended  to 
treat  exhaustively  of  the  numerous  questions  of  theory  that 
are  associated  with  the  science.  That  is  entirely  beyond  the 
scope  of  a  work  that  is  prepared  especially  for  him  who, under 
the  circumstances  of  a  comprehensive  curriculum  of  study 
crowded  into  a  period  of  time  all  too  short,  must  of  necessity 
limit  his  reading  in  all  subjects  to  those  texts  which  give  but 
a  comparatively  brief  treatment.  This  work  therefore,  is 
rather  but  an  outline  of  the  various  subjects  that  are  most 
closely  related  to  the  fundamentals  of  the  science,  with  sug- 
gestions as  to  the  direction  further  investigation  should  take. 

The  various  subjects  outlined  and  the  manner  of  their 
treatment  are  the  result  of  the  labor  of  the  author  which  has 
been  especially  devoted  to  the  principles  of  osteopathy  during 


PREFACE. 

his  course  as  teacher  in  the  American  School  of  Osteopathy 
for  the  past  three  years.  In  large  part  the  work  here  pre- 
sented is  a  revision  of  lectures  delivered  before  the  classes  in 
Principles  of  Osteopathy. 

The  work  is  divided  into  Parts  I  and  II,  indicating  a  dif- 
ference in  the  nature  and  arrangement  of  the  matter  treated. 
This  difference  lies  in  the  more  general  nature  of  the  sub- 
stance of  Part  I,  the  more  specific  in  Part  II.  Certain  funda- 
mental propositions  bearing  on  the  general  problems  of  life, 
health,  and  disease  are  discussed  in  the  former,  while  the  de- 
ductions drawn  therefrom  are  applied  specifically  in  the  lat- 
ter to  the  various  regions  of  the  body. 

Acknowledgment  of  indebtedness  is  hereby  made  to  all 
those  who,  either  directly  or  indirectly,  have  aided  in  the 
elaboration  of  the  subject  matter,  and  in  the  preparation  of 
the  volume.  To  Dr.  A.  T.  Still,  the  founder  of  the  science, 
special  thanks  are  due  for  continued  oversight  and  frequent 
correction — a  fact  for  which  is  felt  the  deepest  gratitude.  Dr. 
Charles  Hazzard,  the  pioneer  as  an  author  of  a  text  book, 
and  an  exponent  of  osteopathy  of  wide  and  enviable  reputa- 
tion, has  as  teacher  and  co-laborer,  been  of  very  material  aid 
and  inspiration  in  the  work.  Other  members  of  the  faculty 
of  the  American  School  of  Osteopathy,  as  well  as  numerous 
practitioners  in  the  field  have  incidentally  or  specifically  con- 
tributed to  the  material  which  has  been  systematized  and 
formulated  in  this  volume.  To  Dr.  C.  M.  T.  Hulett,  of  Cleve- 
land, Ohio,  the  author  is  under  obligation  for  many  sugges- 
tions, and  especially  for  his  patience  and  care  in  reading  the 
manuscript. 

Kirksville,  Mo.,  August,  1903. 


CONTENTS. 


PART  I. 


CHAPTER  I. 
INTRODUCTORY. 
An  Evolution,  12. 

Hippocrates,  Galen,  Paracelsus,   Harvey,   Sydenham, 
Haller,  Virchow,  Ling,  Hilton,  Pasteur,  Koch,    Klebs, 
Krukenberg. 
The  Revolution,  18. 

CHAPTER  II. 

SOME  FUNDAMENTAL  CONSIDERATIONS. 

The  Boundaries  of  Osteopathy,  20 
Definition,  Legal,  Technical. 

The  Viewpoint  of  Life,  22. 

Definition  of  Life,  Vital  Force,  Basis  for  Functioning, 
Law  of  Change. 

Structure  and  Function,  25. 

Develop  Co-ordinately,  First  Product. 

Cell  Doctrine  Insufficient,  27. 

Ante-cellular  Elements,  Cellular  Structure,  Protoplas- 
mic Bridges,  Syncytium,  Body  as  a  Whole,  Chains  of 
Disorders,  Administration  of  Drugs,  Inheritance. 

Cause  of  Disease  not  in  the  Cell,  32. 

Auto-intoxication,  LaGrippe,  Blood  or  Nerve  Influence, 
Error,  Modify  Conditions,  Inherently  Healthy. 

Man  a  Machine,  36. 

Machine,  Mechanism. 

The  Body  a  Chemical  Laboratory,  38. 

Conditions  Needful,  Fundamental  Facts,  Inferences, 
Iron,  Fibrin. 

CHAPTER   III. 

SOME  FUNDAMENTAL  CONSIDERATIONS  (CON.). 
The  Energy  of  the  Body,  43. 

Conservation  of  Energy,    Transformation  of    Energy 


2  PRINCIPLES   OF   OSTEOPATHY. 

Chemical  Action,  Molecular  Attraction,  Mass  Attrac- 
tion, Mechanical  Energy,  Nerve  Energy,  Potential  vs 
Kinetic,  Summary. 

Body  Fuel,  53. 

Essential, Metabolism,  Reserve  Supplies,  Average  Diet, 
Dining,  Disease  Conditions. 

More  than  a  Machine,  59. 

Self -sufficiency  of  the  Organism,  60. 

Self-regulating  Power,  Functionally  in  Health,  In 
Disease,  Structurally,  Fundamental  Proposition. 

Tendency  to  the  Normal,  64. 

Normal  Condition,  Symptoms,  Heredity,  Adaptation, 
Both  Necessary,  Physical  Principles,  Chemical  Princi- 
ples, Vital  Principles,  Association  of  the  Three. 

CHAPTER  IV. 

THE  ETIOLOGY  OP  DISEASE. 

Abnormal  Structural  Conditions,  69. 

Gross  Anatomical  Disturbances,  Why  Limit  the  Appli- 
cation, Evidence. 
Disease  Maintained  by  Structure,  72. 

Original  Stimulus,  Acute  Conditions,  Predisposition. 
The  Lesion,  75. 

Definition,  Positional  Relations,  Size  Relations. 
Media  through  which  Lesions  Produce  Disease,  77. 

Direct  Pressure,  Artery, Vein,  Lymph  Channel, Nerves. 
Miscellaneous  Notes,  80. 

Vitality  of  Tissue,  Adjustment  Possibilities,Transferred 

Pain,  Other  than  Pain  Conditions. 
The  Causes  of  Lesions,  84- 

External,  Internal. 

CHAPTER  V. 

THE  ETIOLOGY  OF  DISEASE  (CoN.). 
Abuse  of  Function,  88. 

Over-use,  Under- use,  Perverted  Use. 
Predisposing  and  Exciting  Causes,  91. 

Definition,  Reversibility  of  Causes. 


CONTENTS.  3 

Germ  Theory  of  Disease,  94. 

Definite  Relation,  Buzzards,  Manner,  Immunity,  Con- 
clusion. 

CHAPTER   VI. 

THE  DIAGNOSIS  OF  DISEASE. 

The  Symptom,  101. 

Heart  Rate,  Pain, Temperattire,Vomiting  and  Diarrhoea, 
Rapid  Respiration,  Glycosuria,  Inflammatory  Condi- 
tions, Disadvantage,  Definition. 

Methods  of  Examination,  106. 

Inspestion,  Palpation,  Percussion,  Auscultation,  Men- 
suration. 

The  Diagnosis  of  Lesions,  109. 

Functional  Activity,  Functional  Rest,  Perversion  of 
Function,  General  Attitude,  Position,  Sensory  Change, 
Definition  of  Pain,  Direct,  Referred,  Segmental  Struc- 
tures, Referred  Tenderness,  Tender  Spots,  Associated 
Muscle  Tissue,  Amplitude  of  Movement,  Temperature 
Change,  Color. 

CHAPTER  VII. 

THE  TREATMENT  OF  DISEASE. 

Prophylaxis  and  Therapeutics.  121. 

Prophylaxis,  Therapeutics,  Higher  Plane. 

Curative  versus  Palliative  Treatment,  125. 

Adjustment  of  the  Osseous  Lesion,  126. 

Exaggeration  of  the  Lesion,  Rotation,  Pressure. 

Adjustment  of  Muscular  Lesions,  129. 

For  Diagnosis,  Preliminary  to  Further  Treatment,  Pri- 
mary in  Itself,  Removal  of  Cause,  Pressure,  Stretching, 
Approximation  of  Origin  and  Insertion. 

Treatment  of  Other  Lesions,  137. 

Perverted  Size  Relations,  Connective  Tissue. 

CHAPTER  VIII. 

THE  TREATMENT  OF  DISEASE  (CON.). 
Stimulation  and  Inhibition,  140. 
Definition. 


PRINCIPLES   OF  OSTEOPATHY. 

Difficulties  in  Direct  Control,  143. 

Nerve  Functions,  Different  Functions,  Unusual  Situ- 
ations, Direct  Manipulations,  Reflex  Basis, -Proportion 
to  Need,  Recoil. 

Objections  to  Direct  Control,  147. 

Interfere  with  Normal  Function,  Reaction,  Conceal- 
ment, Treatment  Habit,  Choice  of  Evils. 

Indications  for  Attempts  at  Direct  Control,  150. 

Lesion  not  Apparent,  After  Removal,  Impossible  Re- 
moval, Force  Obstruction,  Tide  Over  a  Crisis,  Treat 
Symptom. 

Do  We  Stimulate  or  Inhibit,  152. 
Deceptive  Terms,  Summary. 

Treatment  of  Disease  Caused  by  Abuse,  155. 

Negative,  Where  Unable  to  Abstain,  Simple  Absti- 
nence. 

Miscellaneous  Notes,  157. 

Lesions  not  Immediately  Removed,  Lesions  not  Entire- 
ly Removed,  Frequency  of  Treatment,  Length  of 
Treatment,  Rapidity  of  Movement,  Possibility  of  Harm. 

CHAPTER  IX. 

COMPARISON  WITH  OTHER  SYSTEMS. 

Drug  Therapy,  164. 

Empirical  Method,  Stimulant,  Sedative,  Neutralization, 
Substitution,  Germicide,  Results,  Real  or  Satisfactory, 
Combat  Effects,  Adds  to  the  Burden,  Cumulative  Ef- 
fect, Other  Organs  not  Involved,  Habit  Formation,  Un- 
certainty. 

Electrotherapy,  174. 

Curative  Value,  Effective  or  Satisfactory,  Roantgen 
Ray,  Phototherapy. 

Hydrotherapy,  177. 

Thermal  Agent,  Stimulant,  In  Constipation. 

Psychotherapy,  179. 
The  Principle. 

Mechanotherapy,  181. 

Massage,  History,  Swedish  Movements,  Summary, 
Technique,  Special  Effects,  New  Growths,  Control  of 
Circulation,  Nerve  Massage  and  Vibration,  Tender 


CONTENTS.  £ 

Points,  Non-essential  Differences,  Essential  Distinc- 
tion. 

Summary,  190. 

Similarity  of  Basis,  Stimulant  or  Sedative,  Neutraliza- 
tion, Substitution,  Destroy  the  Micro-organism,  Abso' 
lute  Difference. 


PART  II. 


CHAPTER  X. 
THE  SPINE. 

General  Survey,  194. 

Contour,  Rigid  Spine,  Lateral  Curvatures,  Single  Ver- 
tebrae, Aerial  Number,  Position,  Other  Points,  Relative 
Use,  Median  Furrow,  Tenderness,  Contracture,  Sounds, 
Average  Lesion  Slight  in  Extent. 

General  and  Specific  Effects  of  Spinal  Lesions,  202. 
Spinal  Lesion,  Entire  Field. 

A  Typical  Condition,  203. 

Torsion,  Artery,  Vein,  Lymphatic,  Spinal  Nerve,  Sym- 
pathetic Nerve. 

The  Sympathetic  System,  206. 

Embryology,  Gangliated  Cords,  Plexuses,  Connection, 
First  Type  White  Ramus,  Second,  Third,  First  Type 
Grey  Ramus,  Second,  Third,  Fourth,  Fifth,  Last, 
Functions,  Possibilities  of  Disorder. 

The  Vaso -Motor  System,  214. 

Definition,  Two  Classes,  Local  Mechanisms. 

Spinal  Lesions  Affecting  Vaso-Motors,  216. 

Striking  Fact,  Irritation,  Not  Simple  Condition,  Mus- 
cle Contracture,  Radiation  of  Impulses,  Hart's  Theory. 

Other  Effects,  223. 

Other  Functions,  Secondary  Contracture. 

CHAPTER  XI. 

CERVICAL  LESIONS — DIAGNOSIS  AND  TREATMENT. 
Superficial  Structures,  226. 

Examine  in  Different  Functional  Conditions,  Horizontal 


6  PRINCIPLES   OF  OSTEOPATHY. 

Position,  Sternomastoid,  Scaleni,  Posterior  Muscles, 
Hyoid,  Throat  Structures,  Tonsils,  Cartilages,  Thyroid 
Gland,  Vascular  and  Nervous  Structures. 

Cervical  Vertebrae,  234. 

Examination,  Atlas,  Axis,  Third  to  Filth,  Seventh. 

Adjustment  of  Cervical  Vertebrae,  240. 
Principles,  Methods,  Posture. 

Inferior  Maxillary  Bone,  243. 

Examination,  Lesions,  Treatment,  Effects. 

CHAPTER  XII. 

CERVICAL  LESIONS — EFFECTS. 

Effects  From  Direct  Pressure,  246. 
Spinal  Cord,  Thyroid  Gland. 

Effects  From  Vascular  Obstruction,  247. 

Carotid  System,  Vertebral,  Intervertebral,  Thyroid. 

Effects  on  Spinal  Nerves,  251. 

Cervical  Plexus,  Brachial  Plexus. 

Effects  on  Cranial  Nerves,  254. 

Fifth,  Facial,  Glosso-Pharyngeal,  Vagus,  Spinal  Ac- 
cessory, Hypoglossal. 

Effects  on  Cervical  Sympathetics,  258. 

Superior  Cervical  Ganglion,  Middle,  Inferior,  Connec- 
tion with  Spinal  Nerves,  Eye,  Ear,  Fauces,  Respiratory 
and  Alimentary  Canals,  Heart,  Thyroid  Gland,  Minor 
Plexuses,  Grey  Rami  to  Cord. 

CHAPTER  XIII. 

THORACIC  AND  LUMBAR  LESIONS — SPINAL. 

Thoracic  Lesions — General,  266. 

Examination,  Flat  Interscapular  Region,  Overcome  the 
Condition,  Lateral  Swerve,  Thickened  Ligaments,  Pos- 
terior Convexity,  Overcoming  the  Posterior  Curve,  Dr. 
Still's  Chair. 

Thoracic  Lesions — Local,  276. 

Torsion,  Separations,  Anterior  Luxations. 

Lumbar  Lesions,  277. 

Noting  the  Condition,  Curvatures,  Single  Vertebrae, 
Overcoming  Lesions. 


CONTENTS.  7 

CHAPTER  XIV. 

THORACIC  AND  LUMBAR  LESIONS — COSTAL. 
Examination,  282. 

Different  Positions. 
Some  General  Types,  284. 

Fiat  Chest,  Barrel-shaped  Chest,  Box-shaped  Chest. 
Single  Ribs,  286. 

Landmarks,  Articular  Mechanisms,  Forms  of  Lesions, 

Tenderness,  Contracture. 
Special  Ribs,  291. 

Atypical,  First  Rib,  Floating  Ribs,  Examination,    Up- 
ward Displacement,  Posterior  End. 
Adjustment  of  Ribs,  296. 

Considered  as  a  Whole,  Vertebral  Disturbance,  Specific 

Movements,  First  Rib,  Floating  Ribs. 
Sternum  and  Cartilages,  302. 

Primary  Disorders,  Treatment. 
The  Clavicle,  304. 

Slight  Subluxations,  Treatment. 
The  Scapula,  306. 

Change  in  Position,  Treatment. 

CHAPTER  XV. 

THORACIC  AND  LUMBAR  LESIONS — EFFECTS. 

Direct  Pressure,  308, 
Flattened  Chest. 

Vascular  Obstruction,  308. 

Intervertebral  System,  Lumbar  Vessels. 

Spinal  Nerves,  309. 

Thoracic,  Lumbar  Plexus,  Sacral  Plexus,  Nerve 
Trunks,  Sympathetic  Fibres. 

Sympathetic  Nerves,  312. 

Cervical  Ganglia,  Heart  and  Aorta,  Arm,  Lungs,  Stom- 
ach, Liver,  Spleen  and  Pancreas,  Intestines,  Ovary 
and  Uterus,  Kidney,  Hypogastric  Plexus,  Generative 
Organs,  Supporting  Tissues,  Lower  Limbs. 

Direct  Pressure  from  Ribs,  328. 

Lungs,  Heart,  Abdominal  Organs,  Stomach  and  Intes- 
tines. 


8  PRINCIPLES   OF   OSTEOPATHY. 

Rib  Pressure  on  Vascular  Channels,  332. 

Double  Effect,  Superior  Opening,    Intercostal  System, 

Diaphragm. 
Rib  Pressure  on  Nerves,  336. 

Superior  Opening  of  Thorax,  Intercostals. 

CHAPTER  XVI. 

PELVIC  LESIONS. 

Examination  and  Diagnosis,  339. 

Pelvis,  Landmarks,  Examination,  Upward  Subluxa- 
tion,  Length  of  Limb,  Determination  of  Length,  Which 
Limb  Involved,  Posterior  Superior  Spines,  Anterior 
Superior  Spines,  Lesions  of  Sacrum. 

Adjustment  of  Pelvic  Structures,  346. 

Withdrawing  the  Wedge,  Other  Methods,  Wheel  and 
Axle,  Knee,  Pubic  Articulation. 

Lesions  of  Coccyx,  349. 

Coccygeal  Articulation,  Common  Subluxation,  Treat- 
ment, Coccyx  Alone. 

Effects  of  Pelvic  Lesions,  351. 
Direct  Pressure,  Vessels. 

Effects  on  Nerves,  352. 

Sacral  Plexus,  Spinal  Nerves,  Pelvic  Plexuses,  Bladder, 
Uterus,  Organs  of  Generation,  Secondary  Disorders. 


PART    I  . 


CHAPTER  I 


INTRODUCTORY. 

A  statement  of  the  principles  which  underlie  the  science 
of  osteopathy  must,  in  the  nature  of  things,  be  a  very 
incomplete  one.  No  one  recognizes  the  fact  more  thoroughly 
than  does  the  practitioner  himself  when  he  is  compelled  to 
apply  theoretical  propositions  to  actual  cases.  Nor  should  he 
be  astonished  at  the  discovery.  If,  as  we  continually  re- 
iterate, osteopathy  is  a  system  built  upon  the  facts  of  anatomy 
and  physiology,  then  the  foundation  must  be  an  absolute  and 
knowable  one  before  we  may  presume  to  pronounce  the  build- 
ing in  any  sense  complete.  Unfortunately  for  the  building,, 
the  foundation  itself  is  incomplete,  but  "ever  becoming."  It 
is  a  perennially  recurring  surprise  to  the  students  of  the  bio- 
logical sciences,  to  learn  that  in  comparison  with  what  is  yet 
to  be  determined,  the  total  bulk  of  demonstrable  fact  relating 
to  these  sciences  is  infinitesmal.  "When  the  student,  in  tak- 
ing up  the  study  of  osteopathy,  is  told  that  the  osteopath  is 
successful  by  virtue  of  his  complete  knowledge  of  anatomy 
and  physiology,  he  glories  in  the  assertion.  But  when  he 
learns,  as  he  certainly  will,  that  the  most  expert  is  equipped 
with  only  a  meager  supply,  he  is  likely  to  be  disappointed. 
True,  in  anatomy  we  are  comparatively  well  grounded,  but 
our  knowledge  of  physiology  and  its  related  sciences  is  ex- 
tremely unsatisfactory  and  must  remain  so  for  long.  Why 
need  we  then  apologize  for  an  incomplete  statement  of  the 
principles  of  osteopathy?  But  another  fact  is  very  apparent. 

Dr. Still  himself  has  repeatedly  asserted  that  osteopathy  is  yet 

2 


10  PRINCIPLES   OF   OSTEOPATHY. 

V 

in  its  infancy.  Why  pretend  then  that  there  be  any  possibility 
of  presenting  it  in  the  garb  of  maturity.  Because  of  its 
youth,  we  must  be  content  with  a  proper  modesty  of  state- 
ment. It  is  unfortunate  that  in  the  rapid  growth  of  the  system 
and  in  the  increase  in  number  of  its  adherents,  time  has  not 
been  given  sufficiently  to  a  careful  analysis  and  record  of 
cases  which  tend  to  substantiate  the  fundamental  propositions ; 
and  since  only  an  infinite  number  of  observed  instances  will 
thoroughly  satisfy  the  demands  of  inexorable  logic,  sufficient 
data  has  not  yet  been  collected  to  warrant  unqualified  state- 
ment. A  careful  presentation  then  of  certain  very  general 
but  unequivocal  propositions,supplemented  by  numerous  pro- 
visional ones,  is  the  duty  of  him  who  would  formulate  a  "plan 
and  specification,"  upon  which  the  practitioner  is  to  build  his 
superstructure. 

It  is  further  necessary  to  make  a  fairly  clear  distinction 
between  principles  and  practice.  It  is  a  pecular  character- 
istic of  the  average  beginner  to  long  for  the  opportunity  to 
observe  and  experiment  upon  cases.  He  has  imbibed  the 
idea  that  osteopathy  consists  essentially  in  the  performance 
of  certain  movements  upon  the  patient,  which  in  one  sense  is 
correct.  But  it  is  necessary  to  emphasize  that  before  such 
movement  shall  be  intelligently  applied,  certain  fundamental 
facts  are  essential;  and  it  is  in  the  development  of  these  re- 
quired facts  that  the  principles  of  osteopathy  consist^.  Dr. 
Still  has  emphasized  in  his  Philosophy  of  Osteopathy  and  time 
and  again  by  word  of  mouth  that  a  "plan  and  specification" 
is  necessary  before  intelligent  work  can  be  done.  There 
must  be  in  the  mind  of  the  student  a  "living  picture,"  not 
only  of  the  form  and  feature  but  also  of  the  function,  the  ten- 
dencies toward  and  away  from  the  line  marked  out  by  hered- 
ity, and  every  phase  and  fact  that  may  be  known  regarding 
the  complete  life  of  the  individual.  It  is  true  no  such  pic- 
ture was  held  by  the  pioneer  in  earlier  times.  It  is  true  that 
osteopathy  like  all  other  sciences  had  its  beginning  as  an  art. 
It  is  no  discredit  to  the  science  that  the  art  occupies  first 


INTRODUCTORY.  11 

place  in  point  of  time.  Musicians  and  poets  are  "born"  and 
the  art  of  music  and  poetry  existed  long  before  the  laws  of 
harmony  and  metre  were  known.  But  it  is  significant  that 
there  are  few  great  poets  or  musicians  who  are  ignorant  of 
the  laws  underlying  their  art.  The  farmer  may  be  able  to 
produce  a  crop  with  no  knowledge  whatever  of  the  chemistry 
of  soils  or  the  laws  of  plant  growth;  but  the  present  develop- 
ment of  agriculture  could  never  have  been,  had  not  such  laws 
been  discovered  and  formulated.  The  school  teacher  may  be 
able  to  instill  knowledge  into  the  minds  of  the  young  and 
still  be  ignorant  of  pedagogics,  but  he  can  never  occupy  first 
place.  In  osteopathy  we  have  no  exception  to  this  rule.  In 
his  Autobiography  Dr.  Still  mentions  the  fact  that  while  yet  a 
boy,  a  case  of  headache  was  aborted  incidental  to  the  resting 
of  his  sub-occipital  region  within  a  rope  swing.  That  was  the 
art  of  osteopathy.  Similiar  cases  and  observation  of  other 
facts  accumulated  until  an  inkling  was  obtained  of  a  law  un- 
derlying the  several  facts.  The  recognition  of  that  law  and 
the  application  of  it  to  still  further  cases  constituted  the  be- 
ginning of  the  science.  The  facts  continually  accumulating 
with  few  Exceptions  that  could  not  be  explained,  and  their 
systematization,  justified  the  presentation  of  a  working  hy- 
pothesis. It  is  the  discussion  of  this  hypothesis  and  the 
facts  substantiating  it,  the  taking  it  as' far  as  may  be  from  the 
realm  of  theory  into  the  realm  of  demonstration,  that  con- 
stitutes the  principles  of  osteopathy.  The  application  of  the 
principles  to  specific  cases  of  disease  constitutes  the  practice 
of  osteopathy. 

A  system  of  healing  cannot  properly  be  separated  from  a 
philosophy  of  life.  This  is  true  by  virtue  of  the  involved 
nature  of  disease.  We  may  prate  of  pure  science  and  declare 
that  we  will  accept  nothing  not  susceptible  of  demonstration, 
and  that  a  system  of  healing  must  depend  for  its  perma- 
nency upon  pure  facts  of  observation.  We  may  insist  that 
laboratory  knowledge  is  the  only  brand  that  will  be  permitted 
to  enter  the  sacred  field  of  science.  And  yet  the  fact  re- 


12  PRINCIPLES   OF   OSTEOPATHY. 

mains  that  the  details  of  every  branch  of  learning  have  been 
wrought  out  and  established  through  the  application  of  pre- 
concieved  theories  based  upon  comparatively  few  facts.  The 
beginning  of  knowledge  comes  by  induction,  but  its  comple- 
tion is  only  accomplished  by  deduction.  A  theory  of  life  is 
at  the  basis  of  the  osteopathic  science.  The  proof  that  it  is 
a  law  rather  than  a  theory  is  the  problem  of  the  osteopathic 
reasoner  and  practitioner.  That  proof  must  of  necessity  re- 
quire time,  and  inasmuch  as  confirmative  evidence  is  daily 
accumulated,  let  no  one  be  discouraged. 


AN  EVOLUTION  AND  A  REVOLUTION. 

What  is  that  philosophy?  It  is  both  an  evolution  and  a 
revolution.  To  make  our  position  clear  it  is  necessary  to  look 
back  into  history  and  trace  out  so  far  as  may  be  possible  the 
evolutionary  outcropping^  that  have  appeared  from  time 
to  time, culminating  finally  in  a  condition  that  has  made  possi- 
ble the  revolution  inaugurated  by  Dr.  Still. '  If  we  turn  to  antiq- 
uity, we  find  an  abundance  of  philosophy  with  little  of  fact. 
Remedial  agencies  were  employed  with  little  regard  to  the 
nature  or  the  manifestations  of  the  disease;  which  is  not  to 
be  wondered  at,  because  of  the  paucity  of  knowledge  regard- 
ing the  body  either  in  a  condition  of  health  or  disease.  It  is  true 
the  records  would  indicate  that  in  the  time  of  the  Ptolemies, 
post-mortems  were  held;  the  ancient  Brahmins  were  aware 
of  the  variations  in  the  specific  gravity  of  the  urine  depend- 
ent upon  diseased  conditions,  and  practiced  a  crude  form  of 
urinalysis.  In  some  respects  the  remedial  measures  of  that 
day  may  be  considered  a  lost  art,  for  the  legends  have  it  that 
measures  were  known,  the  use  of  which  would  prevent  the 
pitting  of  smallpox,  and  antidotes  efficient  for  the  most  ven- 
omous of  snake  poisons  were  compounded.  The  Chinese  rec- 
ognized the  diagnostic  value  of  changing  conditions  of  the 
pulse,  though  the  connection  between  the  condition  observed 


INTRODUCTORY.  13 

and  the  remedy  employed  is  unexplained.  The  Hebrews, 
while  recognizing  certain  fundamental  facts  in  regard  to  the 
ethical  relations  existing  between  man  and  man,  and  the 
moral  relations  between  man  and  his  Creator,  gave  to  the 
world  little  of  value  in  the  way  of  treatment  of  individual  body 
conditions.  The  world  is,however,indebted  to  that  race  for  the 
most  elaborate  system  of  hygienic  matters  that  has  been  devised, 
some  of  the  provisions  of  which  might  well  be  incorporated 
in  modern  sanitary  regulations.  Until  the  era  of  Hippocrates 
little  was  given  to  the  world  of  a  permanent  nature  that 
would  assist  in  solving  the  problems  of  disease  and  death. 
In  Hippocrates (460— 37 7 B.C.) the  medical  world  recognizes 
its  first  great  figure,  not  so  much  by  virtue  of  any  great 
depth  of  reasoning,  but  by  virtue  of  his  ability  to  observe, 
and  further,  by  his  recognition  of  the  necessity  for  recording 
his  observations.  Hence,in  the  Hippocratic  collection  of  writ- 
ings we  find  a  vast  field  covered,  embracing  as  it  does  every 
branch  of  the  healing  art,  both  of  prophylaxis  and  thera- 
puetics.  Hippocrates  further  deserves  the  title,  "Father  of 
Medicine,"  because  of  his  work  in  gathering  together  not 
only  his  own  observations,  but  those  which  he  considered 
worthy  of  others  of  his  time  and  those  who  preceded  him. 
It  must  be  noted,  however,  that  the  value  of  the  observations 
of  Hippocrates  lies  in  their  relation  to  the  symptoms  rather 
than  to  the  explanations  or  the  treatment  of  disease.  He 
added  to  the  knowledge  of  effects  but  not  to  the  knowledge  of 
cause  or  its  removal.  The  philosophers,  Aristotle  and  Plato, 
with  their  contemporaries,  dealt  largely  with  speculation  and 
little  with  experimental  determination.  It  is  interesting  to 
note  that  in  their  time  arose  the pneuma  theory, or  the  theory  of 
the  spirits,  which  in  effect  was  the  precursor  of  Priestley's 
demonstration  a  thousand  years  later,  of  the  presence  of  oxy- 
gen in  the  air  and  of  the  important  role  that  element  plays 
in  all  life  processes.  The  same  era  produced  Empedocles 
and  Heraclitus,  who  with  their  theories  of  evolution  and  the 
struggle  for  existence,  respectively,  anticipated  Darwin  and 


14  PRINCIPLES    OF   OSTEOPATHY. 

his  followers,  and  which  in  the  last  half  century  has  so  pro- 
foundly modified  every  phase  of  the  life  question. 

While  the  modern  biological  investigator  has  reverence 
for  the  name  and  fame  of  Hippocrates,  he  recognizes  in  the 
Roman  anatomist  Galen(131 — 201  A.  D.)  the  first  investi- 
gator endowed  with  the  so-called  scientific  spirit.  That 
spirit  was  manifested  in  experimental  methods  of  study 
which  were  careful  for  that  age  of  the  world.  As  an  anat- 
omist and  physiologist,  Galen  was  able  to  disprove  some  of 
the  contentions  of  the  Hippocratic  school  as  well  as  to  add  a 
considerable  number  of  important  facts  to  existing  knowledge 
by  dissections  and  vivisections.  That  Galen's  influence  was 
profound  and  permanent  is  evidenced  from  the  fact  that  cer- 
tain of  his  classifications  are  still  employed, and  that  for  four- 
teen centuries  his  word  was  law.  In  spite  of  his  contribution  to 
biological  knowledge, Galen  added  in  a  direct  .way  not  a  whit 
to  the  understanding  of  the  cause  or  the  treatment  of  disease. 

From  the  time  of  Galen  throughout  the  Middle  Ages  up  to 
the  fifteenth  century,  little  advance  was  made  in  any  of 
the  sciences  related  to  the  healing  art.  Through  the  schools 
of  France,  Italy,  and  Spain, fact  and  tradition  were  preserved 
unmodified.  All  knowledge  centered  in  the  records  of  Galen 
until,with  the  general  revival  of  learning1  individuals  once 
more  began  to  investigate  and  reason  for  themselves.  A 
striking  character  arose  early  in  the  sixteenth  century.  Dis- 
putant, philosopher,  mystic  and  egotist,  Paracelsus  (1493 — 
1541)  proclaimed  to  the  world  a  profound  contempt  for  the 
learning  of  the  past  as  recorded  in  books, insisted  that  know- 
ledge must  be  gained  subjectively,  and  formulated  a  theory 
of  nature.  Three  of  his  affirmations  we  wish  to  emphasize: 
first,  all  nature  is  a  unit;  second,  nature  is  never  complete,  but 
forever  becoming;  third,  nature  is  a  macrocosm,  man  a  microcosm. 
That  these  three  ideas  have  become  part  and  parcel  of  mod- 
ern thought,  is  a  proposition  requiring  little  substantiation. 
The  close  relation  that  they  bear  to  the  osteopathic  doctrine 
becomes  more  and  more  apparent  with  further  study.  From 


INTRODUCTORY.  15 

this  time  forward  the  path  of  history  is  marked  with  the 
names  of  individuals  who  stand  out  prominently  because  of 
added  biological  facts  or  demonstrable  theorems.  Harvey 
(1578 — 1657)  gives  to  us  the  proofs  of  a  complete  circulation 
and  the  dictum  never  yet  refuted,  omne  vivum  ex  ovo,  the 
former  of  which  had  been  suggested  by  Galen  and  by  others 
less  noted.  We  need  hardly  dwell  upon  the  importance  of 
both  of  these  facts  to  the  osteopath.  Van  Helmont(1577 — 
1644)  a  follower  of  Paracelsus, emphasized  the  inter-relations 
between  matter  and  energy,  and  suggested  the  doctrine  of 
ferments  as  explaining  the  digestive  processes.  The  philos- 
opher, Descartes  (1596 — 1650), while  emphasizing  certain  and 
numerous  ideas  of  a  general  nature  regarding  matter  and 
mind,  gave  rise  to  one  concept  that  is  of  the  utmost  signifi- 
cance to  the  osteopath.  The  idea  that  wan  is  a  machine  and 
the  operation  of  his  organism  is  dependent  upon  mechanical 
laws,  is  a  view  fundamental  to  osteopathic  reasoning,  and  to 
Descartes  we  are  under  obligations  for  that  emphatic  state- 
ment. Growing  out  of  this  conception  arose  the  iatromechan- 
ical  school,  whose  chief  advocates,  Borelli  (1608—1679)  and 
Marey  of  our  time,  have  made  the  application  chiefly  to  the 
systems  of  animal  movement;  while  a  rival  school,  the  iatro- 
chemical,  founded  by  Sylvius,  insisted  on  the  application  of 
chemical  principles  as  explanatory  of  various  functions.  At 
this  stage  in  the  historical  development  we  find  an  immense 
impetus  given  to  the  investigation  of  the  problems  of  life 
through  the  invention  of  the  compound  microscope  where- 
by not  only  the  cellular  theory  of  living  structure  was  form- 
ulated, but  also  the  discovery  was  made  of  microscopic  forms 
of  life.  This  was  followed  first  by  the  interminable  discus- 
sion of  spontaneous  generation  and  later  gave  birth  to  the  germ 
theory  of  disease — a  theory  which  has  profoundly  modified 
medical  thought  and  practice  during  the  closing  years  of  the 
nineteenth  century.  In  the  latter  half  of  the  seventeenth 
century  the  English  physician  Thomas  Sydenham,  em- 
phasized another  fact  which  is  basic  to  osteopathic  theory. 


16 


PRINCIPLES   OF   OSTEOPATHY. 


He  made  emphatic  claims  for  the  healing  power  of  nature  and 
thereby  anticipated  the  contentions  of  all  those  of  later  time 
who  insist  that  it  is  nature  who  cures  and  not  the  physician. 
Priestly,  in  the  latter  half  of  the  eighteenth  century,  by  his 
discovery  of  the  element  oxygen  was  able  to  replace  in  sub- 
stantial form  the  pneuma  of  the  early  philosophers,  which,  en- 
tering the  body  through  the  breath  gave  life  to  its  tissues. 
Haller  (1708 — 1777),  following  Glisson  in  the  investigation 
of  the  property  of  irritability,  enlarged  upon  the  conception 
of  a  vital  force  underlying  all  life  phenomena  and  independ- 
ent of  known  chemical  and  physical  laws— a  conception 
Vhich  still  commands  the  adherence  of  a  respectable  number 
of  scientists,  and  which  is  yet  perhaps  neither  susceptible  of 
proof  nor  disproof.  The  relation  existing  between  physiolog- 
ical activity  and  electricity  has  been  the  subject  of  study 
since  Galvani  (1737 — 1798)  proved  the  generation  of  electric 
currents  by  living  tissues,  and  the  recent  facts  of  physical 
chemistry  regarding  the  electrical  nature  of  certain  chemical 
reactions  bid  fair  to  throw  further  light  upon  the  part 
played  by  electric  energy  in  the  body  organism. 

During  the  nineteenth  century  a  few  figures  stand  out 
strongly  in  the  further  development  of  biology.  In  special 
prominence  we  note  the  tendency  of  all  modern  investigators 
to  an  objective  study,  leaving  severely  alone,  too  severely  we 
believe,  all  matters  of  a  speculative  nature.  Hahnemann 
(1755 — 1843), with  his  "law  of  similars"  and  his  insistence  on 
smaller  dosages,  has  most  profoundly  modified  the  practice  of 
heroic  drugging  which  had  reached  an  alarming  stage. 
Virchow  (1821 — 1902)  with  his  investigation  into  the  pathol- 
ogy of  cells,  has  cleared  up  many  of  the  mysteries  associated 
with  pathologic  conditions,  incidentally  throwing  light  upon 
the  general  cell  doctrine, although  his  views  and  those  of  his  fol- 
lowers can  but  be  regarded  as  extreme  and  in  some  respects 
impossible.  Ling'(1776 — 1839),  by  virtue  of  his  systematiz- 
ation  of  the  various  methods  of  movement  cures,  gave  an  im- 
petus to  the  study  of  the  physiological  effects  of  mechanical 


INTRODUCTORY.  17 

stimuli,  a  fact  which  has  led  to  no  little  confusion  both  on 
the  part  of  the  laity  and  profession,  in  regard  to  the  distinc- 
tion between  these  various  methods  and  that  of  osteopathic 
practice.  Hilton,  the  English  surgeon,  has  emphasized 
Sydenham's  contention  relating  to  the  healing  power  of  na- 
ture, in  its  surgical  aspects,  and  has  served  to  show,  inno- 
cently enough,  the  essential  identity  in  the  standpoint  of  os- 
teopathy and  conservative  surgery.  Pasteur  and  Koch 
and  Klebs  and  a  host  of  others,  through  their  investigations 
of  the  processes  of  fermentation  in  and  out  of  the  body,  to- 
gether with  the  demonstration  of  the  close  relationship  be- 
tween disease  and  micro-organisms,  have  greatly  added  to 
our  knowledge  of  the  pathological  changes  taking  place  in 
specific  diseases,  although  their  explanation  of  such  rela- 
tionship is  not  accepted  in  its  entirety  by  the  osteopath. 
Modern  biologists  have  added  a  vast  amount  of  data  to  the 
sum  of  knowledge  accumulated  in  the  past,  and  to  them  the 
members  of  all  the  schools  of  healing  are  greatly  indebted. 
In  so  far  as  that  knowledge  has  been  applied  in  explaining 
the  cause  of  disease  and  suggesting  its  treatment  there  is  a 
pitiable  poverty.  The  ground  work  for  a  rational  system 
was  laid.  The  inauguration  of  that  system  remained  for  a 
leader.  The  use  of  drugs,  which  had  come  to  occupy  first 
place  among  the  healing  agencies, was  found  sadly  wanting. 
As  early  as  the  first  half  of  the  last  century,  the  tendency  of 
the  later  time  was  stated  by  Krukeiiberg,  a  German  phy- 
sician, in  these  words  as  quoted  by  Park:  "Physicians 
should  be  filled  with  a  pious  reverence  toward  nature;  the 
organism  is  a  whole  and  must  be  contemplated  in  this  sense; 
medical  art  is  undoubtedly  capable  of  decisive  action,  but 
let  us  not  mistake  that  in  many  cases  its  activity  is  quite 
superfluous,  in  very  many  null  and  inadequate,  and  in 
many  injurious."  That  there  has  been  a  remarkable  turn- 
ing away  from  drugs  in  the  last  half  century  is  evidenced 
from  numerous  facts.  Note  the  rise  of  Christian  Science  and 
the  numerous  other  cults  whose  systems  are  based  on  the  re- 


18  PRINCIPLES   OF  OSTEOPATHY. 

lation  between  mind  and  body,  which  number  their  adher- 
ents by  the  millions,  and  whose  reputed  cures  emphasize 
Krukenberg's  statement  that  in  many  cases  medical  art  is 
superfluous,  and  substantiates  Syndenfiam's  declaration  that 
the  healing  power  resides  in  nature;  electrotherapy  for  a 
time  flourished  and  still  has  its  enthusiastic  admirers ;  hydro- 
therapy  has  become  an  adjunct  of  practically  all  systems,  the 
use  of  which  has  been  emphasized  to  the  ignoring  of  its  abuse 
which  in  reality  has  been  productive  of  the  greater  results; 
the  development  of  serotherapy  co-existent  with  the  develop- 
ment of  a  knowledge  of  toxins  produced  by  pathogenic  bac- 
teria has  had  far  reaching  results;  the  known  facts  relating 
to  internal  secretions,  together  with  the  observation  of  path- 
ologic conditions  resulting  from  the  absence  of  some  organ, 
usually  a  ductless  gland,  has  led  to  the  rise  of  organotherapy, 
and  has  served  to  distinguish  between  organic  food  elements 
and  inorganic  chemical  substances.  The  rise  of  these  vari- 
ous systems,  all  indicating  the  desertion  of  the  drug,  has  not 
been  dependent  upon  a  realization  by  the  physician  alone  of 
the  inadequacy  of  the  drug,  but  equally  upon  that  realization 
by  the  thinking  laity.  The  time  was  ripe  for  a  revolution 
in  the  conception  of  cause  and  treatment  of  disease. 

THE  REVOLUTION. 

It  was  stated  that  in  osteopathy  not  only  was  there  an 
evolution  but  there  was  a  revolution.  Heretofore  the  phy- 
sician had  confined  his  attention  to  appearances,  which  in 
truth  was  all  that  he  could  do,  inasmuch  as  the  cause  re- 
mained unknown.  Every  system  of  treatment  thus  far  de- 
veloped had  been  one  designed  primarily  to  combat  effects. 
It  remained  for  Dr.  Still  to  determine  the  fundamental  cause  of 
all  disease,  and  to  inaugurate  a  system  of  treatment  based 
upon  that  cause;  and  in  the  statement  that  perverted  struc- 
tural conditions  prevent  the  return  to  normal  functions  we 
have  the  essence  of  the  osteopathic  doctrine, and  in  the  appli- 
cation of  measures  designed  to  remove  these  structural  condi- 


INTRODUCTORY.  19 

tions,  we  have  the  essence  of  that  revolution.  Dr.  Still's 
great  work  then  lies  in  the  determination  of  cause,  and 
through  a  knowledge  of  that  cause,  the  application  of  an  ef- 
fective treatment.  The  study  of  the  nature  of  this  revolu- 
tion in  its  various  general  and  detailed  aspects,  constitutes 
the  subject  matter  of  the  remainder  of  this  volume. 


20  PRINCIPLES   OF  OSTEOPATHY. 

CHAPTER  II. 


SOME  FUNDAMENTAL  CONSIDERATIONS. 


THE  BOUNDARIES  OF  OSTEOPATHY. 

All  systems  and  sciences,  whether  related  to  healing  or 
other  aspect  of  human  endeavor, are  a  result  of  growth.  Growth 
presupposes  a  beginning  less  mature  than  the  end.  Hence  it 
were  presumption  at  the  present  time  to  attempt  to  set  definite 
limits  to  the  science  of  osteopathy.  Professor  Ladd  of  Yale 
states  a  very  important  fact  when  he  says  that  the  proper 
definition  of  a  science  is  one  of  the  latest  and  most  difficult 
achievements  of  that  science. Recognizing  the  extreme  youth  of 
osteopathy  we  must  be  content  with  only  a  provisional  setting 
of  limitations  in  any  attempt  at  a  statement  of  its  constituent 
elements.  Admitting  this  to  be  the  case,  yet  we  do  not  deem 
it  presumption  to  attempt  to  formulate  in  a  concise  manner  the 
essential  ideas  in  the  form  of  what  may  be  called  a  definition. 
We  protest  against  the  position  that  is  assumed  by  some  that 
there  cannot  be  a  platform  upon  which  we  may  stand.  Our 
system  must  have  a  basis,  staunch,  unshaken,  if  it  shall  stand. 
We  are  willing  to  listen  with  patience  to  the  presentation  of 
new  facts  that  may  cause  us  to  modify  our  platform,  but  these 
must  come  as  fact  and  not  as  theory  before  we  shall  recede 
from  the  principles  enunciated  in  that  platform.  And  so  far 
in  the  history  of  the  system  the  original  conception  still  re- 
mains unimpaired,  even  though  sometimes  hastily  considered 
inadequate  to  cover  the  ground.  We  believe  that  if  care  is 
taken  to  analyze  the  facts  it  will  be  found  that  instead  of  modi- 
fying the  original  concept,  they  do  but  confirm  and  make  it 
the  more  impregnable.  It  is  needless  to  say  that  a  single  word 
cannot  indicate  in  any  comprehensive  way  the  nature  of  the 
system.  Hence  we  have  no  intention  to  explain  in  any  apolo- 


SOME  FUNDAMENTAL   CONSIDERATIONS.  21 

getic  and  compromising  terms  why  the  word  osteopathy  came 
to  be  used.  We  do  insist,  however,as  compared  to  the  termin- 
ology of  other  systems  it  comes  much  more  nearly  striking 
the  keynote,  and  is  far  superior  to  any  other  name  that  has 
been  suggested. 

The  legal  definition  given  to  the  system  by  the  statutes 
refers  to  it  as  a  "system,  method,  or  science  of  healing."  We 
must  recognize  at  a  glance  that  it  is  systematic  and  method- 
ical. The  more  pertinent  inquiry  remains,  — is  it  a  science? 
That  it  is  not  a  completed  science  we  have  already  by  infer- 
ence emphasized.  That  it  embraces  all  the  elements  of  a 
science  we  affirm.  The  definitions  that  have  been  given  for 
the  word  science  have  been  many  and  various.  Succinctly, 
"systematized  truth"  may  serve  the  purpose  as  well  as  many 
of  a  more  pretentious  character.  In  so  far  as  the  facts  that 
have  been  gathered  when  arranged  in  definite  logical  order 
tend  to  support  a  definite  hypothesis  we  have  a  science.  In 
so  far  as  the  conditions  in  disease  are  shown  to  depend  in  defi- 
nite ways  upon  certain  properties  of  the  structural  arrange- 
ments, thereby  occupying  the  relation  of  cause  and  effect,  we 
have  the  essentials  of  a  science.  Finally,  inasmuch  as  anat- 
omy and  physiology  are  sciences, osteopathy, which  is  but  the 
application  of  these  two  toward  the  cure  of  disease,  must  par- 
take also  of  the  nature  of  a  science.  True,  there  are  many 
things  yet  to  be  reconciled,  yet  to  be  classified,  but  that  fact 
does  not  in  any  way  impair  its  validity  as  a  science. 

Not  touching  upon  the  details  that  remain  yet  to  be  work- 
ed out  a  technical  definition'  must  suggest  a  concept  of  the 
cause  and  the  treatment  of  disease.  In  regard  to  the  latter  it 
must  not  only  embrace  therapeutics  but  prophylaxis  as  well. 
For  medicine  in  the  broad  use  of  that  term  must  include  not 
only  measures  employed  to  assist  the  body  in  recovering  its 
equilibrium  but  also  those  designed  to  assist  the  organism  in' 
maintaining  that  equilibrium.  Indeed  the  latter  is  logically 
of  far  greater  importance,  but  because  of  an  unfortunate  ten- 
dency on  the  part  of  human  nature  to  procrastination  the  for- 


Y        V  ^          V 

(/ 

22  PRINCIPLES   OF   OSTEOPATHY. 

mer  will  of  necessity  demand  the  most  of  the  physician's  labor. 
In  order  that  our  definition  shall  include  essentials  and  give 
to  us  a  basis  of  support  the  following  propositions  must  be 
either  directly  or  by  inference  included : 

1.  Cure  is  the  prerogative  of  the  organism. 

2.  Functional  disorders  will  be  self -adjusted  except  where 
complicated  with  or  dependent  on  structural  disorders  which 
are  beyond  the  limits  of  self -adjustment. 

3.  Removal  of  structural  disorders  constitutes  the  treat- 
ment. 

In  accordance  with  these  provisions  we  have  in  another 
publication  (Journal  of  the  American  Osteopathic  Association, 
May,  1902)  suggested  the  following  definition  of  osteopathy: 
A  system  of  therapeutics  which,  recognizing  that  the  maintenance  and 
restoration  of  normal  function  are  alike  dependent  on  a  force  inherent 
in  bioplasm,  and  that  function  perverted  beyond  the  limits  of  self- 
adjustment,  is  dependent  on  a  condition  of  structure  perverted  beyond 
those  limits ,  attempts  the  re-establishment  of  normal  function  by  mialni&- 
ulative measures  designed  to  render  to  the  organism  such  aid  as  will 
enable  it  to  overcome  or  adapt  itself  to  the  disturbed  structure.  The 
elaboration  of  the  various  provisions  in  the  above  definition 
will  appear  as  the  subject  is  further  developed  in  the  follow- 
ing chapters. 

The  science  then  by  virtue  of  its  recognition  of  the  inter- 
relations between  structure  and  function  is  eminently,  as  has 
been  so  often  stated,  the  application  of  anatomy  and  physiol- 
ogy to  the  cure  of  disease. 

THE  VIEWPOINT  OF  LIFE. 

We  have  spoken  of  the  fact  that  a  system  of  healing  can- 
not be  separated  from  a  philosophy  of  life.  As  introductory 
to  a  further  study  of  the  osteopathic  doctrine  it  is  necessary 
to  consider  in  brief  a  few  aspects  of  the  life  problem.  Not 
that  it  is  possible  to  give  an  accurate  definition  of  life;  for 
it  "is  obvious  that  no  such  definition  can  be  given  of  a  thing; 
the  essential  nature  of  which  is  unknown.  For  we  know-  not 


SOME   FUNDAMENTAL   CONSIDERATIONS.  23 

what  life  is ;  we  are  only  acquainted  in  part  with  the  substance 
with  which  life  is  associated  and  with  a  few  of  its  manifesta- 
tions. "We  know  that  in  one  sense  life  is  a  property  of  a  certain 
kind  of  molecule  (Wilson),  but  the  explanation  of  that  property 
and  how  it  is  associated  with  the  molecule  is  not  forthcoming. 
We  know  that  life  is  inherent  in  this  certain  kind  of  mole- 
cule. ^  Dr.  Still  has  stated  that  life  is  an  individualized  principle 
of  nature.  jA  part  of  the  universal  life  has  become  in- 
dividualized in  an  aggregation  of  protoplasmic  molecules. 
How  it  became  thus  individualized,  and  at  death  it  again  be- 
comes merged  into  the  universal  life,  is  yet  and  in  all  likeli- 
hood will  always  remain  a  mystery. "  The  materialist  hopes 
sometime  to  be  able  to  explain  life  in  terms  of  physics  and 
chemistry.  While  it  is  true  a  large  number  of  functions 
formerly  considered  vital,  in  the  sense  of  being  out  of  the 
realm  of  physics  and  chemistry,  have  in  more  recent  years 
been  satisfactorily  explained  on  purely  physical  or  chemical 
laws,  yet  avast  number  of  much  more  difficult  facts  of  func- 
tion remain  entirely  beyond  physical  or  chemical  explana- 
tion. Until  these  are  explained  and  life  is  shown  to  be  but 
a  peculiar  arrangement  and  action  of  atoms  in  a  peculiar 
molecule  with  no  hyper- mechanical  or  hyper- chemical 
actors,  we  must  assume  the  presence  of  an  essence  which 
for  lack  of  a  better  term  is  called  the  vital  force.  This  con- 
ception corresponds  with  Dr.  Still's  "matter,  motion  and 
mind."  We  shall  not  attempt  to  identify  the  vital  force  with 
mind.  The  argument  for  or  against  that  contention  is  purely 
a  matter  of  speculation.  Suffice  it  to  notice  that  a  force  of 
some  kind  animates  all  living  matter  and  is,  so  far  as  can  bo 
at  present  determined,  outside  the  realm  of  matter  and  mo- 
tion. This  force  apparently  initiates,  controls  and  co-ordi- 
nates function  throughout  the  entire  organism.  It  is  a  force 
continuous  throughout  the  entire  organism  through  the  med- 
ium not  alone  of  blood  continuity,  nerve  or  cell-contiguity, 
but  also  through  the  less  known  but  undoubtedly  important 
fact  of  protoplasmic  continuity  to  which  we  shall  later  refer 


24  PRINCIPLES   OF   OSTEOPATHY. 

in  more  detail.  Truer  words  were  never  spoken  than  those 
used  by  Krukenberg  and  suggested  by  others  that  "the  or- 
ganism is  a  whole  and  must  be  contemplated  as  such."  Re- 
cent biologists  have  called  attention  to  the  fact  that  proto- 
plasmic bridges  exist  between  cells  in  a  remarkably  large 
number  of  organs  and  tissues,  and  Spencer's  suggestion  is 
significant  that  a  particle  of  protoplasm  may  during  the 
course  of  time  pass  to  all  parts  of  the  body. 

While  it  is  not  possible  to  accept  the  materialist's  con- 
ception of  living  matter  yet  recognition  must  be  made  of  the 
fundamental  importance  of  chemical  and  physical  law  as 
a  basis  for  functioning.  The  chemical  nature  of  pro- 
toplasm is  significant;  composed  of  a  dozen  or  more  of  the 
known  elements  most  of  which  are  of  low  atomic  weight,  we 
find  a  very  complex  molecule.  If  paramount  importance  can 
be  assigned  to  any  single  element,  nitrogen  could  reasonably 
be  placed  first.  That  element  is  characteristic  of  living  ma- 
terial and  is  fundamental  in  the  way  of  giving  to  the  complex 
molecule  its  own  peculiarities.  Nitrogen  unites  with  a  suffi- 
ciently large  number  of  other  elements  but  in  comparatively 
loose  combinations,  separating  readily  to  form  new  associa- 
tions. It  is  in  this  respect  that  nitrogen  is  fundamental  to 
the  living  molecule.  The  most  striking  characteristic  of  liv- 
ing tissue  is  its  tendency  to  continual  change — not  only  of  a 
physical  but  also  of  a  chemical  nature.  The  response  to  a 
stimulus  is  dependent  upon  this  readiness  and  since  life  may 
be  considered  in  large  part  a  response  to  stimuli  the  necessity 
for  the  ability  to  change  becomes  apparent.  In  this  connec- 
tion Spencer's  classical  definition  of  life  is  illuminating: 
"  The  continuous  adjustment  of  internal  relations  to  external  rela- 
tions.''1 As  we  shall  have  occasion  to  repeatedly  refer  to  the 
fact  of  adjustment  this  conception  of  life  should  be  borne  in 
mind.  Every  change  in  the  environment  of  the  organism 
constitutes  a  stimulus  of  greater  or  less  intensity  upon  that 
organism.  The  continuous  proper  response  to  these  stimuli 
represents  a  normal  condition  of  the  organism ;  a  failure  to- 


SOME   FUNDAMENTAL   CONSIDERATIONS.  25 

respond,  or  a  response  too  intense  or  insufficient  is  evidence 
of  and  further  sause  for  a  disease  condition.  In  the  sense  of 
a  continuous  response  to  continuous  stimuli  the  organism 
constitutes  amoving  equilibrium.  When  that  equilibrium  be- 
comes disturbed  by  too  intense  or  too  prolonged  stimuli  dis- 
ease results,  while  in  the  continuous  adjustment  to  circum- 
stances we  have  the  normal  condition  of  the  living  organism 
maintained. 

Considering  life,  then,  in  certain  of  its  manifestations, 
we  are  led  to  the  conviction  that  the  law  of  change  is  a 
law  of  living  matter  as  represented  in  man.  The  study  of 
those  changes  and  the  determination  of  methods  to  assist  the 
organism  in  its  response  to  stimuli,  constitutes  the  life  pro- 
blem and  the  problem  of  the  physician. 

STRUCTURE  AND  FUNCTION. 

In  this  continual  adjustment  dependent  on  change  in 
the  physical  and  chemical  relations  of  the  molecule  above  re- 
ferred to,  it  is  to  be  noted  that  both  structure  and  function 
are  concerned.  Discussions  are  rife  regarding  the  relative 
position  of  structure  and  function  in  the  development  of  an 
individual  or  of  a  race.  We  shall  not  enter  into  the  argu- 
ment except  to  attempt  to  show  that  for  all  practical  purposes 
the  two  develop  co-ordinately.  That  structure  changes  y 
function  must  be  admitted  in  countless  cases.  This  fact  is 
fundamental  in  osteopathic  theory,  according  to  which  most 
diseases  are  either  causedjjrjj^intained  DY  structural  con- 
ditions interfering  with  function.  On  the  other  hand  it  is 
equally  certain  that  in  numerous  cases  we  have  evidence  of 
the  modifying  influence  of  function  on  structure. 

The  cell  doctrine  as  commonly  understood  is  insufficient 
to  explain  the  phenomena  of    the  complex,    organized  living 
being.     The  cell  represents  the  expression  of  life  which  is  in- 
herent in  the  common  s^nicjtu£alba^is,  protoplasm.      It  re-     7 
mains  further  to  state,  as~Dr.  Stilf  Itfjnself  has   emphasized,      » 
that  protoplasm  is  the  first  product  of  the  life  essence. 


<r 

26  PRINCIPLES   OI\  OSTEOPATHY. 

There  is  an  organizing  force  that  lies  back  of  all  structure. 
That  force  is  unknown  but  it  represents  an  action,  an  energy, 
a  function.  In  this  sense  we  are  justified  in  insisting  that 
function  is  a  cause  of  structure.  We  may  follow  out  this  as- 
sertion, however,  with  the  equally  obvious  statement  that 
before  that  organizing  force  can  express  itself  in  any  sub- 
stantial way  it  must  have  a  structural  basis.  That  structural 
basis  is  protoplasm.  In  this  view  of  the  matter  we  are  justi- 
fied in  claiming  that  structure  governs  function.  Through- 
out the  growing  period  of  the  individual,  function  is 
continually  changing  structure.  Marey  calls  attention  to  the 
development  of  grooves  and  depressions  in  the  growing  bone 
from  the  continual  functional  activity  of  the  growing  muscle 
and  other  soft  tissues:  As  the  individual  uses  to  excess 
one  group  of  muscles,  the  prominences  to.  which  the 
muscles  are  attached  will  be  correspondingly  increased. 
The  muscle  itself,  as  in  the  case  of  the  heart  in  certain  val- 
vular disorders,  becomes  remarkably  hypertrophied.  A  dis- 
order of  the  stomach,  through  the  increase  of  nerve  impulses 
that  pass  from  it,  initiates  changes  which  result  in  perver- 
sions of  form,  more  noticeable  in  [the  case  of  muscle  tissue. 
All  of  these  are  instances  of  the  power  of  function  to  modify 
structure.  In  large  part,  it, will  be  noted  that  the  functioning 
energy  only  modifies  the  structure  in  the  process  of  growth, 
compensation,  or  any  condition  where  a  definite  purposeful 
action  seems  necessary.  As  soon  as  the  functional  activity 
or  the  energizing  force  has  brought  forth  and  builded  its  own 
instrument  of  manifestation,  observation  of  the  human  body, 
that  of  the  lower  animal,  and  to  an  equal  extent,  plant  life, 
all  show  that  function  then  becomes  subject  to  the  mechanical 
conditions  of  the  structure  and  form.  Thence  on,  more 
markedly  than  during  the  previous  period  of  growth  or  com- 
pensation, structure  becomes  modified  only  inappreciably  and 
gradually  by  the  function.  The  structure,  through  various 
forces  acting  upon  it,  is  in  considerable  part  unable  to  im- 
mediately adjust  itself ,  with  the  result  that  the  function  must 


SOME   FUNDAMENTAL   CONSIDERATIONS.  27 

immediately  suffer  and  continue  so  to  do  until  the  structural 
condition  be  overcome.  Therein  lies  the  essence  of  the  whole 
argument.  Admitting  that  function  can  modify  the  structure, 
it  much  more  readily  can  modify  itself  and  hence  is 
perfectly  self-adjusting.  On  the  other  hand,  structure  is  only 
passively  self-adjustive,  and  hence  will  likely  remain  in  its 
abnormal  condition  until  some  external  force  is  brought  to 
bear.  During  all  the  time  of  structural  disorder  the  function 
will  of  necessity  be  disturbed  and  disease  will  result.  Struc- 
ture representing  the  channels  through  which  the  life  forces 
manifest  themselves  becomes  comparatively  unyielding.  The 
function  remaining  active,  so  long  as  structural  conditions  . 
are  maintained,  will  be  self-regulated.  i\  jL^-c  4JL***>A 


THE  CELL  DOCTRINE  INSUFFICIENT. 

From  the  middle  of  the  seventeenth  century  when  Schlei- 
den  and  Schwann  discovered  in  the  case  of  plants  and  ani- 
mals respectively  that  living  material  was  divided  into  innum- 
erable microscopic  parts  having  a  more  or  less  definite  shape, 
up  to  the  present  decade,  the  cell  doctrine  has  been  growing 
in  importance  as  one  of  the  great  facts  of  biology.  When  the 
nature  of  the  cell  was  first  determined  and  the  essential  ele- 
ments had  been  differentiated  from  the  non-essential,  it  was 
believed  that  a  long  step  had  been  taken  toward  the  solution 
of  many  of  the  life  problems.  As  the  investigator  learned 
that  each  of  these  individual  divisions  had  a  more  or  less  dis- 
tinct life  of  its  own,  the  attention  of  the  physiologist  was 
turned  from  a  consideration  of  the  action  of  the  cell  groups 
to  that  of  the  individual  cell,  until  in  the  literature  of  to-day 
the  statement  is  constantly  reiterated  that  the  problem  of 
physiology  is  the  problem  of  the  cell.  Virchow,  in  his  mon- 
umental work  on  the  cell  structure  with  special  reference  to 
its  pathology,  has  emphasized  more  than  any  one  man  the  in- 
dividuality of  the  cell  and  the  fundamental  necessity  for  nor- 
mal cell  life  in  order  that  body  activity  as  a  whole  shall  be 
normal.  To  detract  from  his  reputation  is  not  the  part  of 


28  PRINCIPLES   OF   OSTEOPATHY. 

wisdom  or  a  thing  at  all  possible  or  desirable,  but  it  must  be 
insisted  that  the  problem  of  physiology  can  never  be  solved  by  the 
rule  of  the  cell,  and  that  for  the  simple  reason  that  the  cell  is 
not  the  fundamental  element  in  living  tissue.  Within  later 
years  the  extreme  views  have  been  modified  and  modern  in- 
vestigators are  searching  for  the  demonstration  of  what  we 
may  provisionally  call  the  ante-cellular  elements.  That 
such  exist  there  can  be  little  question.  That  is,  more  simple 
elements  which  have  the  fundamentaljlife  faculties,  lie  back 
of  the  cell  and  are  responsible  for  the  cell,  f  If  we  were  asked 
to  suggest  the  simplest  possible  conception  of  life  in  its  manifes- 
tation, we  would  insist  that  protoplasm,  plus  an  organ- 
izing force  dwelling  within  that  protoplasm  constitutes  the 
simplest  conceivable  life  condition!]  This  conception  is  not 
that  of  the  cell  doctrine.  The  strucjifral  conditions  necessary 
in  the  cellular  arrangement  are  but  one  of  the  expressions  of 
the  life.  As  Wilson  puts  it,  "All  parts  of  the  cell  are  but  the 
local  differentiation  of  a  common  structural  basis."  The  cyto- 
plasm is  one  specialization,  the  nucleoplasm  is  another,  and 
the  cell  wall  is  a  third  of  the  specializations  of  this  structural 
basis.  It  is  not  enough  to  say  that  there  must  be  the  com- 
bination of  nucleus  and  cytoplasm  in  order  that  life  may  be 
manifested.  It  is  a  common  statement  that  the  nucleus  is 
necessary  and  hence  any  protoplasm  devoid  of  a  nucleus 
cannot  represent  the  fundamental  unit.  We  affirm  that  cyto- 
plasm does  live  and  does  manifest  life  after  having  been  sep- 
arated from  all  connection  with  nucleoplasm.  It  shows  amoB- 
boid  movement,  it  is  irritable,  it  flows  about  nutrient  sub- 
stances and  digests  them.  Hence  life  is  still  present,  and 
without  question  there  are  present  more  elementary  biolog- 
ical units.  To  the  objection  that  the  cytoplasm  very  soon 
dies,  and  under  no  circumstances  can  reproduce  itself,  we 
may  reply  that  the  same  is  true  of  any  of  the  complete  cells 
of  multicellular  man  when  they  have  become  separate.  It  is 
purely  a  question  of  degree  and  length  of  life'and  not  one  of 
kind. 


SOME   FUNDAMENTAL   CONSIDERATIONS.  29 

With  modern  methods  of  research,  our  knowledge  of  the 
actual  structural  conditions  of  the  human  body  has  been  con- 
siderably increased  and  in  large  part  corrected.  One  of  the 
more  striking  of  the  observations  which  bear  directly  upon 
the  subject  in  hand,  has  reference  to  the  fact  that  the  body  is 
by  no  means  entirely  made  up  of  cellular  structure.  It 
has  long  been  known  that  in  the  case  of  plants  numerous 
of  their  cells  were  structurally  continuous.  The  same 
fact  has  been  shown  to  be  true  in  the  case  of  animals.  In 
the  developing  ova  of  fishes  it  has  been  found  that 
the  cells  as  they  were  formed  were  not  separated  but 
still  maintained  the  continuity  of  their  protoplasm.  The]same 
is  true  with  reference  to  the  ovarian  cells  of  mammals.  In  the 
higher  animals,  including  man,  many  epithelial  cells  on  close 
inspection  show  the  presence  of  protoplasmic  bridges, 
which  is  significant  as  bearing  on  its  relation  to  the  secretory 
activity  of  epithelium.  Cartilaginous  and  many  other  forms 
of  connective  tissue  cells  are  connected  through  protoplasmic 
extensions.  In  the  case  of  the  muscle  cells  of  the  heart  we  have 
a  typical  condition.  There  the  cells  are  markedly  branching 
and  the  branches  are  continuous  one  with  another.  This  is 
of  fundamental  interest,  as  throwing  light  upon  the  peculiar 
properties  of  the  cardiac  muscle.  It  has  long  been  known 
that  the  contraction  of  the  heart  takes  the  form  of  a  wave 
passing  downward  from  the  sinus  venosus  to  the  apex.  It 
was  formerly  assumed  that  this  wave  was  propagated  from 
auricle  to  ventricle  through  the  medium  of  nerve  connection. 
This  has  been  shown  to  be  erroneous,  since  the  nerve  tissue 
can  be  rendered  ineffective  while  the  propagation  of  the  wave 
remains  unaltered.  What  is  the  explanation?  Older  anatom- 
ists taught  that  there  was  no  muscular  connection  between 
auricle  and  ventricle.  This,  according  to  Gaskell,  has  been 
disproved  and  it  is  now  known  that  the  propagation  of  the 
contraction  wave  from  auricle  to  ventricle  takes  place  through 
a  continuity  of  muscle  protoplasm.  While  the  continuous 
nature  of  cardiac  muscle  cells  has  long  been  known,  it  is  only 


30  PRINCIPLES   OF   OSTEOPATHY. 

within  more  recent  years  that  proof  was  given  for  a  similar 
though  less  marked  condition  in  the  case  of  all  involuntary 
muscle  tissue.  This  becomes  of  special  interest  because  of  the 
long  known  fact  that  a  contraction  wave  started  at  one  end 
of  the  intestinal  canal  passes  through  a  greater  or  less  ex- 
tent of  the  tract  without  further  stimulus.  Therein  further 
lies  the  suggestion  of  an  explanation  of  the  Traube-Herring 
curves  which  are  produced  by  the  rhythmic  action  of  the  ar- 
terial walls  and  which  are  entirely  independent  of  the  pulse. 
According  to  one  investigator  of  recent  years,  up  to  the  time 
that  the  white  corpuscle  passes  out  into  the  lymph  or  blood, 
while  it  is  seemingly  perfect  in  its  development  it  remains 
still  attached  by  protoplasmic  filaments  to  the  mother  cells  in 
the  lymphoid  tissue.  It  is  even  suggested  that  the  appear- 
ances indicate  a  power  on  the  part  of  the  white  cell  of  reform- 
ing its  attachments.  If  this  be  true,  the  already  known  func- 
tions of  the  1  eucocyte  would  be  prodigiously  increased  and 
the  possibilities  from  that  power  would  appear  to  be  infinite. 

From  the  above  considerations  it  would  seem  that  the 
conception  of  the  human  body  as  a  syncjrtium  is  not  at  all 
inappropriate,  and  that  there  is  justification  for  the  conclu- 
sion stated  by  Meyer,  (Wilson  on  "The  Cell")  that  "both  the 
plant  and  the  animal  individual  are  continuous  masses  of  protoplasm 
in  tvhich  the  cytoplasmic  substance  forms  a  morphological  unit  whether 
in  the  form  of  a  single  cell,  a  multi-nucleated  cell,  or  a  system  of  cells." 

While  it  is  impossible  at  the  present  time  to  prove  that 
this  protoplasmic  continuity  is  present  to  any  extreme  degree 
in  the  human  body  there  is  much  to  be  said  in  favor  of  it  as 
an  abstract  proposition.  We  have  continually  referred  to  the 
necessity  of  considering  the  body  as  a^  whole  and  not  as  an 
aggregation  of  independent  particles.  (.  This  is  fundamental 
in  the  osteopathic  philosophy  and  practice.J  If  the  body  is  a 
syncytium  then  the  practice  of  removal  of  any  organ  of  the  body 
because  of  its  supposed  absence  of  function  is  fundamentally  erroneous. 
All  organs  and  all  parts  of  the  body  will  perform  to  a  certain 
extent  all  functions  of  the  body.  While  there  is  specializa- 


SOME   FUNDAMENTAL    CONSIDERATIONS.  31 

tion  no  part  of  the  body  will  completely  lose  its  original 
properties.  This  emphasizes  the  fact  that  in  the  human  or- 
ganism we  have  the  most  complex  as  well  as  the  most  simple  func- 
tioning capacities,  and  as  such  it  can  meet  all  conditions  of  en- 
vironment on  a  common  level,  whether  these  conditions  them- 
selves be  complex  or  simple.  And  this  is  of  importance  in 
the  organism's  struggle  for  existence.  When  man  is  com- 
pelled to  resist  another  organism  of  complex  nature  such  as 
the  mammal  he  may  do  so  by  the  use  of  his  own  special- 
ized complex  nature.  He  can  meet  brain  with  brain  and 
muscle  with  muscle.  Compelled  to  resist  the  effects  of  poi- 
sonous substances, whatever  the  occasion  for  their  presence  in 
his  body, he  may  meet  toxin  with  anti -toxin — a  process  known 
to  take  place.  Compelled  to  withstand  invasion  of  his  own 
body  by  the  unicellular  organism, such  as  a  pathogenic  bacter- 
ium, he  may  meet  cell  with  cell,  for  phagocytosis  is  an  ac- 
cepted physiological  fact.  The  same  idea  is  emphasized  in 
the  case  of  the  internal  secretions.  It  is  known  that  many  of 
the  organs  of  the  body  provide  certain  substances  that  are 
essential  to  the  body  as  a  whole.  If  there  is  a  protoplasmic 
circulation  it  is  doubtless  true  that  every  part  of  the  body 
gives  and  receives  from  every  other  part. 

A  further  interesting  suggestion  along  this  line  refers  to 
the  relation  between  this  protoplasmic  continuity  and  various 
reflex  disorders  and  chains  of  disorders.  A  pathologic 
condition  of  a  group  of  cells  too  slight  to  affect  the  nerve 
connections  or  the  quality  of  the  blood,  may  still  be  capable 
through  the  added  influence  of  the  flow  of  protoplasm,  of 
changing  the  metabolism  of  remote  structures.  This  fact 
would  further  emphasize  the  necessity  for  looking  to  other  parts 
of  the  body  for  lesions  than  merely  to  the  regions  commonly  involved 
through  a  disturbance  of  the  nerve  or  blood  mechanism.  In  like 
manner  we  may  understand  the  deleterious  effects  on  other 
and  all  parts  of  the  body  from  the  administration  of  drugs. 
It  will  thus  be  impossible  to  limit  the  action  of  a  drug  to  the 
tissue  involved  in  the  disease;  once  having  come  in  contact 


32  PRINCIPLES   OF   OSTEOPATHY. 

with  the  protoplasm  of  a  single  cell,  unless  thrown  out  by 
defensive  action,  it  may  pass  to  every  part  of  the  body  with* 
out  leaving  its  protoplasmic  medium. 

A  final  interesting  suggestion  and  one  that  may  throw 
light  upon  the  general  problem  of  the  inheritance  of  dis- 
ease has  reference  to  the  protoplasmic  continuity  as  a  me* 
dium  for  transmitting  through  the  germ  cells  of  the  body,  ele- 
ments from  each  of  the  other  cells.  This  might  suggest  why 
it  is  that  a  child  does  to  all  appearance  inherit  some  peculiar 
quality  in  his  body  or  mental  functioning. 

We  have  thus  emphasized  the  fact  that  there  is  in  all 
probability  a  uniform  protoplasmic  continuity,  in  order  to 
draw  attention  to  the  necessity  of  considering  the  body  as 
much  more  than  the  sum  of  its  parts.  It  is  true  that  the  cells  in- 
dividually exercise  a  profound  influence  over  the  body  as  a 
whole,  but  it  is  equally  true  that  the  body  as  a  whole  exercises 
an  immense  influence  over  the  cell  and  groups  of  cells.  This 
latter  fact  must  be  continually  recognized  in  all  cases  of  di- 
agnosis and  treatment  of  disease. 

CAUSE  OF  DISEASE  NOT  IN  THE  CELL. 

But  in  another  sense  the  cell  doctrine  as  commonly  un- 
derstood is  inadequate.  Virchow  and  others  have  placed 
biologic  science  under  great  obligation  for  numerous  facts 
with  reference  to  the  role  of  cell  metabolism  in  disease.  From 
the  conception  that  the  body  is  an  aggregation  of  groups  of 
cells,  each  of  which  has  its  own  independent  function,  comes 
the  natural  deduction  that  a  disease  of  any  organ  is  due  to  a 
faulty  condition  in  the  activity  of  those  cells.  By  the  dem- 
onstration that  protoplasmic  metabolism  was  able  to  synthe- 
„  jjtfise  various  substances  that  were  auto-toxic,  a  key  to  nu- 
merous diseases  was  believed  to  have  been  found.  So  far  as 

fi  I    fr  " 

,a  superficial  conception  goes,  the  assumption  is  correct.     But 

'  it  is  manifest  that  it    is  a    key    that   unlocks   only   a    single 

door   and  one  which  leads  only  to    further   difficulty.      It  is 

true  that  every  cell  may  produce   substances  which   are   ac- 


SOME  FUNDAMENTAL   CONSIDERATIONS.  33 

tively  toxic  to  its  own  protoplasm  and  to  that  of  its  neighbor 
if  it  be  maintained  in  contact  with  such  substance.  It  is  not 
unlikely  that  any  product  of  normal  katabolism  may  be 
equally  disastrous  if  permitted  to  remain.  Everyone  has 
experienced  the  sensation  of  fatigue.  What  is  the  condition 
present?  Undoubtedly  it  represents  an  excess  of  normal 
waste  material  collecting  in  connection  with  sensory  filaments 
distributed  to  the  muscle  cells.  Every  student  of  physiology 
is  aware  that  in  fatigue  this  toxic  substance  is  produced. 
The  blood  serum  taken  from  a  fatigued  animal  and  injected 
into  the  vascular  system  of  one  in  a  rested  condition,  will 
produce  in  the  latter  every  symptom  characteristic  of  the 
fatigued  animal. 

La  Grippe  produces  similar  symptoms,  and  Verworn 
has  attempted  to  identify  the  two  conditions  or  at  least  to 
show  their  marked  similarity.  In  the  La  Grippe  condition 
there  is  present  a  material  toxic  to  the  cell  and  irritant  to  the 
nerve  terminal,  similar  to  the  effect  of  the  sarcolactic  or 
other  acid  always  present  in  excess  in  overworked  muscle 
tissue.  The  presence  of  the  bacterium  is  not  necessarily  a 
detriment  to  the  organism  but  in  many  cases  pathological 
conditions  are  undoubtedly  caused  in  part  from  its  activity. 
In  these  it  is  not  the  mere  presence  but  the  excretion  pro- 
duct that  constitutes  the  deleterious  influence.  Whether 
it  be  a  toxalbumin  similar  in  kind  to  that  produced  by  body 
activity  remains  to  be  demonstrated.  Sufficient  for  present 
purposes  to  note  the  fact  that  the  material  is  toxic  and  must 
of  necessity  produce  cell  disorder  if  present  in  sufficient 
amount.  Whatever  the  source  of  the  toxic  material,  whether 
it  comes  from  bacteria,  over  exercise, or  perverted  cell  metab- 
olism, it  is  immediately  a  possible  cause  for  harm. 

Cell  metabolism  may  be  abnormal  from  changed  supply 
of  blood  or  nerve  influence.  Undoubtedly  in  the  case  of 
most  cells  of  the  body,  their  activity  is  partly  under  control 
and  co-ordination  of  nerve  influence.  An  excess  of  that  in- 
fluence will  be  the  cause  for  the  accumulation  of  the  kata- 


34  PRINCIPLES   OF   OSTEOPATHY. 

bolic  products  constituting  the  cause  for  fatigue.  This  means 
that  the  nerve  initiates  a  too  rapid  transformation  of  potential 
energy  of  cell  protoplasm  into  kinetic  energy  of  chemical  and 
vital  activity.  This  additional  activity  will  further  initiate 
new  changes  immediate  and  remote  and  a  chain  of  events 
be  inaugurated.  A  deficiency  of  blood  and  nerve  influence, 
on  the  other  hand,  will  permit  of  a  lowered  resistance  to  other 
stimuli,  with  one  or  both  of  two  effects,  a  trophic  change  in 
the  tissue  or  a  perverted  quality  of  metabolism.  In  the  latter 
case  the  complete  products  of  the  normal  "metabolic  cycle" 
will  not  be  formed  and  hence  various  types  of  degeneration 
may  follow. 

These  considerations  have  led  many  into  error.  The 
statement  is  made  that  the  cause  of  disease  resides  in  the 
metabolism  of  the  cell.  This  is  true  only  in  a  limited  sense. 
A  more  nearly  correct  statement  would  be  that  the  disease  is 
the  faulty  metabolism  of  the  cell.  It  remains  to  trace  the 
faulty  metabolism  to  its  source.  It  is  obvious  that,  theoretic- 
ally, numerous  forms  of  stimuli  may  come  into  relation  with 
the  cell  protoplasm  to  modify  its  activity.  Mechanical,  ther- 
mal, chemical,  electric,  nervous — all  are  known  to  affect 
protoplasm.  But  in  every  case  these  influences  must  be 
brought  over  channels  that  connect  cell  with  periphery.  For 
the  cell,  deeply  situated,  is  in  an  environment  of  comparative 
quiet.  Mechanical  pressure  does  not  act  as  a  serious  stim- 
ulus because  that  pressure  is  constant.  Thermal  conditions 
are  unfavorable  for  producing  response  since  it  is  only  a  sud- 
den change  that  is  an  efficient  stimulus.  Chemical  stimuli 
only  reach  it  through  the  medium  of  channels  which  trans- 
mit fluid  capable  of  performing  the  office  of  a  vehicle,  while 
nervous  influences  are  similarly  carried  over  definite  path- 
ways. We  are  thus  brought  face  to  face  with  the  funda- 
mental fact  in  the  osteopathic  concept  that  a  free  channel  be- 
tween cell  and  its  source  of  supply — unobstructed  blood  and 
nerve — is  the  normal  condition  for  protoplasmic  functioning. 
The  connection  between  blood  and  nerve  having  been  made 


SOME   FUNDAMENTAL   CONSIDERATIONS.  35 

such  that  nerve  governs  blood  and  blood  replenishes  nerve, 
the  cell  in  immediate  connection  with  both  is  entirely  depend- 
ent on  the  normal  condition  of  these  for  its  proper  function- 
ing. Over  all  is  exercised  that  co-ordinating  power,  seem- 
ingly inherent  in  protoplasm  and  by] which  the  cell  is  main- 
tained in  balance  between  its  -anabolic  and  katabolic  pro- 
cesses. Hence  so  long  as  the  channels  connecting  cell  with  per- 
iphery be  kept  free,  no  break  in  the  chain  of  events  constitut- 
ing the  metabolic  cycle  is  possible.  The  cell  will  thus  be  able 
to  select  and  reject  at  will.  The  normal  hydrostatic  and  osmotic 
pressures  will  be  maintained  at  such  a  level  as  to  necessitate 
a  correct  functioning  in  vital  selection.  Nutrient  materials 
will  be  taken  in  from  the  blood  with  ease  and  rapidity.  Waste 
materials  will  be  discharged  with  equal  facility.  Fatigue  can- 
not long  persist  since  a  growing  loss  of  irritability  will  neces- 
sitate rest  and  when  rest  is  permitted  the  protoplasm  is  rap- 
idly renewed.  Bacterial  products  though  present  in  the  blood 
will  not  aggravate  for  long,  since  the  function  of  normal  pro- 
toplasm is  to  secrete  anti- toxin.  An  uninterrupted  nerve 
influence  will  keep  up  a  constantly  normal  chemical  and 
vital  protoplasmic  change,  Under  such  circumstances  the 
cell,  vital  and  self -sufficient,  cannot  easily  go  wrong  in  its 
action. 

But  modify  the  conditions  associated  with  the  chan- 
nels of  interchange  and  note  the  result.  Changes  in  blood 
supply  and  drainage  permit  changes  in  osmotic  ~  conditions 
and  hence  changes  in  activity  of  the  cell  selection  and  rejec- 
tion ;  lessened  cell  nutrition  and  cell  regulation  will  result. 
Disturb  nerve  discharge  to  the  cell,  and  excess  or  deficiency 
in  metabolism  results, with  varied  abnormal  tissue  conditions. 
How  will  these  interferences  be  produced?  Largely  by 
changes  in  structural  arrangements  associated  with  a  tissue 
which  is  least  subject  to  vital  control,  i.  e.,  connective  tissue,  bone, 
ligament  and  muscle.  "When  these  are  disturbed  a  lessened 
possibility  of  adjustment  must  result.  Failure  to  supply  the 
blood  with  materials  from  which  the  cell  claims  its  pabulum, 


36  PRINCIPLES   OF  OSTEOPATHY. 

excesses  of  whatever  kind — all  will  have  their  influence,  but 
at  most  it  will  be  but  temporary  and  so  soon  as  the  abuse — 
for  such  it  is — ceases,  repair  is  rapid  and  usually  complete. 
Bacterial  conditions  cannot  harm  the  cell  since  the  blood  is 
germicidal,  antiseptic  and  antitoxic. 

Altogether,  it  would  seem  that  the  cell  representing  a 
definite  bit  of  protoplasm  cannot  of  itself  cause  a  disease  in 
itself  or  in  its  neighbor.  It  is  inherently  healthy  and  is 
utterly  incapable  of  harm  until  the  connection  between  it  and 
its  sources  of  supply  and  channels  for  drainage  becomes  im- 
paired. These  connections  are  represented  by  blood  stream, 
lymph  channel,  continuity  of  protoplasm,  and  nerve  sub- 
stance. Interference^with  these  by  persistent  pressure  from 
displaced  structures^which  are  less  subject  to  vital  control  of 
position,  constitutes  the  factor  which  produces  or  maintains 
the  disturbed  cell  metabolism. 

MAN  A  MACHINE. 

It  has  been  stated  that  underlying  the  practice  of  oste- 
opathy there  is  the  recognition  of  a  close  and  fundamental 
relation  between  structure  and  function.  Reference  was 
made  to  the  fact  that  the  human  body  in  structural  aspects 
partook  of  the  nature  of  a  definite  machine,  the  operation  of 
which  followed  definite  mechanical  laws.  That  man  is  a  ma- 
chine is  an  assertion  trite  enough,  yet  one  that  demands 
some  consideration.  A  machine  is  an  instrument  by  which 
force  is  changed  in  direction  or  intensity,  and  usually  asso- 
ciated with  the  transformation  of  energy.  "While  the  mechanic 
employs  a  vast  number  of  mechanisms  all  may  be  reduced 
to  a  few  simple  machines,  viz.,  the  lever,  the  pully,  the 
wedge.  Each  of  these  is  represented  in  the  human  body. 
Practically  every  action  of  the  voluntary  muscles  is  depend- 
ent upon  the  principle  of  the  lever.  When  one  extends  his 
fore -arm  he  does,  so  by  the  use  of  a  lever  of  the  first  class; 
when  he  forces  his  body  from  a  wall  by  placing  his  hands 
against  it  the  lever  is  of  the  second  class;  when  he  flexes 


SOME   FUNDAMENTAL   CONSIDERATIONS.  37 

his   fore -arm  he  employs  a  lever  of  the  third   class.     Borelli 


FIG.  1. — Illustrating  the  mechanics  of  muscle  and  bone. 

and  Marey  in  their  investigations  relating  to  muscular  action 
of  the  locomotor  organs  have  shown  by  mathematical  and 
other  demonstration  the  nicety  of  adjustment  of  those  Organs 
to  the  work  required  to  be  done,  emphasizing  thereby  the 
purposefulness  of  the  body  structure.  In  the  superior  oblique 

muscle  of  the  eyeball,  in 
the  peroneus  muscle,  and 
in  the  long  head  of  the 
biceps,  are  represented 
the  pulley  action  by  which 
the  direction  though  not 
the  intensity  of  the  force 
is  changed.  In  the  "bag 

FIG.  2. — Illustrating  mechanics  of  the  pulley,     of  Waters"  at  parturition, 

in  the  middle  lobe  of  the  right  lung,  in  peristaltic  action,  and 
in  certain  parts  of  the  process  of  vomiting  we  have  illus- 
trations of  the  principle  of  the  wedge.  The  laws  of  hydro- 
statics and  hydrodynamics  are  made  use  of  in  numerous  cases. 
Pascal's  law  of  fluid  pressure  is  at  the  basis  of  blood  dis- 
tribution and  blood  flow;  capillary  attraction,  osmosis,  filtra- 
tion and  diffusion  play  no  inconsiderable  part  in  body  func- 
tioning; the  fenestra  rotunda  of  the  middle  ear  with  its  mem- 
branous covering  is  a  provision  for  the  law  of  fluid  incom- 
pressibility.  The  laws  of  air  pressure  are  utilized  in  the  pro  - 


A.-  PULLEY  OP   SUP  OBLIQUE. 


38  PRINCIPLES   OF   OSTEOPATHY. 

cesses  of  respiration  and  circulation,  and  in   giving  support 
to  the  articulations  and  the  viscera. 

While  we  recognize  that  man  is  a  machine,  the  term 
mechanism  is  one  more  descriptive  of  the  real  condition 
in  that  the  former  carries  with  it  by  association  the  idea  of 
rigidity  and  unyielding  parts.  This  latter  characteristic  is 
obviously  not  true  of  the  living  organism  in  which  continual 
change  is  characteristic.  Further,  mechanism  involves  the 
idea  of  complexity  which  characteristic  is  markedly  true  of 
the  human  body.  But  it  must  be  borne  in  mind  that  while 
the  latter  term  is  more  descriptive  of  the  actual  body  condi- 
tion, it  involves  largely  the  same  principles  as  does  the 
former. 

THE  BODY  A  CHEMICAL  LABORATORY. 

The  body  is  not  only  a  machine  by  reason  of  which  it  can 
produce  various  changes  in  the  nature  of  the  energy  with 
which  it  comes  into  relation ;  and  through  the  operation  of 
purely  physical  laws  that  are  possible  of  expression  through 
the  arrangements  of  its  numerous  parts  it  can  perform  the 
function  of  a  physical  laboratory.  It  is  in  addition  a  chem- 
ical laboratory,  the  capacities  of  which  have  a  reach  that  is 
entirely  beyond  the  artifice  of  man.  Substances  are  formed, 
torn  down  and  re-formed,  which  have  no  counterpart  in  the 
world  outside  of  organic  life.  No  man  yet  has  been  able  to 
synthetize  living  proteid  from  the  inorganic  or  organic  materi- 
als at  his  command.  We  may  take  the  living  tissue  and 
analyse  it,  but  when  the  analysis  begins  the  proteid  has  lost 
its  life  essence.  What  remains  we  may  analyze  and  determine 
in  part  its  constituents.  We  may  take  of  the  products  of 
living  proteid  and  after  analysis  draw  conclusions  as  to  the 
original  living  tissue.  But  we  are  yet  in  the  dark  as  to  the 
fundamental  quality  in  the  chemical  nature  of  living  proto- 
plasm. Even  the  complete  formula  for  the  dead  protoplasm 
defies  exact  statement.  When  that  is  once  accomplished  we 
then  shall  have  little  reason  to  hope  for  an  immediate  deter- 


SOME  FUNDAMENTAL  CONSIDERATIONS.  39 

mination  of  the  composition  of  the  living  tissue.  For  within 
the  sacred  precincts  of  the  living  proteid  molecule  we  may 
not  go,  and  the  discovery  of  the  intimate  nature  of  that  sub- 
stance must  continue  to  be  a  subject  for  speculation  and  not 
demonstration. 

That  the  conditions  needful  for  chemical  action  are 
markedly  present  in  the  human  organism  need  hardly  be 
emphasized.  Suffice  it  to  suggest  a  few  points  that  call  at- 
tention to  it.  The  body  as  a  whole  is  over  sixty  per  cent 
water.  The  essential  living  part  of  the  body,  i.  e. ,  the  proto- 
plasm, contains  a  sufficiently  greater  amount  to  render  it  dis- 
tinctly fluid.  This  fact  is  of  fundamental  importance  from  the 
standpoint  of  chemical  possibilities  especially.  That  it  is 
fluid  rather  than  solid  is  suggested  by  the  fact  that  it  flows  as 
in  the  case  of  the  streaming  process  noted  in  the  cells  of  cer- 
tain plants;  by  the  tendency  which  the  white  blood  corpuscle 
and  other  typical  protoplasm  exhibits  to  assume  a  spherical 
shape ;  and  the  further  tendency  of  other  fluids  to  assume  that 
shape  when  absorbed  within  an  environment  of  protoplasm 
such  as  is  noticed  in  the  case  of  fat  droplets.  Owing  to  this 
fluid  nature  chemical  action  may  take  place  more  efficiently 
and  more  rapidly,  which  is  a  fact  of  considerable  value  for  the 
purpose  of  quick  response  to  stimuli  so  necessary  to  a  com- 
plex life.  Contained  within  this  fluid  material  we  have  a 
dozen  or  more  of  the  lighter  chemical  elements  held  in  rather 
loose  chemical  combination  so  that  when  materials  from  the 
outside  world  have  become  absorbed  into  the  protoplasmic 
substance  a  rapid  change  of  atomic  and  molecular  associa- 
tions is  readily  effected.  We  have  before  referred  to  the 
fact  that  of  the  elements  found  associated  with  protoplasm  a 
few  seem  to  be  of  fundamental  importance,  namely,  the  oxy- 
gen, the  nitrogen,  and  the  carbon.  A  few  others  seem  to  be 
essential  but  appear  to  perform  a  less  important  role  in  met- 
abolism, while  still  others  in  special  forms  may  be  present  or 
absent.  The  proteid  material  found  in  the  body  is  in  large 
part  what  is  spoken  of  as  combined  proteid.  Verworn  gives  the 


40  PRINCIPLES   OF  OSTEOPATHY. 

following  formula  of  one  of  the  moat  important  of  the  com- 
bined proteids,  namely,  haemoglobin,  which  suggests  the 
extreme  complexity  of  the  substance  and  the  infinite  possi- 
bilities of  re-arrangement  in  the  processes  of  vital  chemistry : 
CeooHgeoNisiFei  830179.  This  represents  but  one  of  a  large 
number  of  the  combined  proteids.  If  we  permit  ourselves 
to  dwell  upon  the  resources  from  which  the  body  chemist 
may  draw  and  the  numerous  products  that  are  continuously 
formed  we  cannot  be  otherwise  than  astonished  at  the  uner- 
ring precision  and  nicety  of  adjustment  which  is  maintained 
throughout  the  life  of  the  normal  individual. 

The  division  point  between  chemical  action  in  the  body 
and  that  dependent  on  other  forms  of  energy  is  not  a  defi- 
nitely determined  one.  Yet  we  know  that  many  of  the  funda- 
mental facts  of  physiology  are  chemical  ones.  Proteid 
foods  in  the  alimentary  canal  are  acted  upon  by  the  pepsin 
and  the  trypsin  and  reduced  to  simpler  and  more  diffusible 
forms  in  a  manner  seemingly  entirely  identical  with  that 
which  takes  place  outside  the  body.  The  oxygen  entering 
the  blood  and  later  the  tissues,  forms  a  combination  with  car- 
bon which  is  identical  with  oxidation  processes  wherever 
found.  Hydrogen  and  oxygen  unite  to  form  water  in  a  man- 
ner similar  to  its  synthesis  elsewhere  so  far  as  can  be  deter- 
mined. Urea,  formed  by  the  liver  cells  from  ammonia  and 
COa  in  the  blood,  is  in  all  likelihood  a  process  similar  to  its 
formation  in  the  chemist's  laboratory.  We  thus  emphasize 
that  the  body  organism  is  capable  of  chemical  possibilities 
not  only  entirely  like  those  outside  organized  life,  but  in  ad- 
dition surpasses'the  known  laws  and  possibilities  of  labora- 
tory chemistry. 

From  the  above  considerations  we  may  draw  several  im- 
portant inferences.  Every  substance  necessary  to  the 
body  in  normal  functioning  will  be  formed  by  the  organism's 
own  chemical  processes.  Iron  compounds  have  for  long 
been  the  staple  remedies  for  anaemia.  In  this  disease  there 
is  a  deficiency  in  the  haemoglobin  of  the  red  corpuscles,  to- 


SOME   FUNDAMENTAL   CONSIDERATIONS.  41 

gether  with  a  deficiency  in  the  number  of  these  bodies  them- 
selves. Iron  is  one  of  the  necessary  elements  for  the  hsemo- 
oglobin.  It  was  assumed  that  by  the  administration  of  the 
iron  compounds  the  deficiency  of  that  element  was  provided 
against.  It  has  been  definitely  proven  that  the  iron  thus  ad- 
ministered passes  through  the  body  unchanged.  But  the 
practice  of  administering  the  iron  still  is  prevalent.  Note 
this  fact :  the  fault  is  not  one  of  a  limited  source  of  iron,  but  a 
limited  power  of  assimilation  of  iron.  The  food  materials  of  an 
ordinary  diet  contain  enough  iron  as  well  as  all  other  ele- 
ments for  all  normal  functioning.  Increasing  the  amount  of 
iron  even  though  it  may  be  assimilable  in  such  form  as  it  is 
given,  which  is  doubtful,  must  of  necessity  fail  as  a  remedial 
measure.  It  has  been  recently  contended  that  arsenic  in 
small  amounts  is  a  constant  constituent  of  certain  of  the 
tissues,  and  from  this  was  derived  the  assumption  that  the 
giving  of  arsenic  in  certain  diseases,  long  a  thing  of  practice 
had  thus  found  its  justification.  Reasoning  could  be  no 
more  faulty.  The  argument  against  iron  in  anasmia  holds 
equally  against  the  use  of  arsenic.  In  both  of  these  cases,  if 
a  deficiency  in  the  assimilation  of  the  substance  be  the  real 
condition,  then  the  logical  consideration  would  be  the  deter- 
mination of  the  faulty  condition  of  the  part  which  prevented 
the  organism  itself  from  selecting  and  utilizing  those  sub- 
stances which  are  found  in  sufficient  abundance  in  the  blood. 
Another  important  deduction  is  this :  when  unusual 
conditions  arise  which  demand  unusual  compounds,  the  latter  will  be 
formed.  Haemorrhage  is  self-limited  in  most  cases.  Why? 
Fibrin,  not  found  in  normal  blood  conditions,  is  immediately 
formed  from  the  interaction  between  thrombin  and  fibrinogen 
which  are  present  either  actually  or  potentially  in  the  blood, 
on  the  exposure  to  air  or  other  foreign  substance.  Thus  the 
blood  clot  is  formed.  Why  are  individuals  immune  from 
certain  diseases?  In  some  cases  by  a  so-called  natural  im- 
munity which  presents  elements  in  the  blood  antagonistic  to 
infective  agents.  In  other  cases  through  the  excessive 


42  PRINCIPLES   OF  OSTEOPATHY. 

activity  due  to  a  previous  attack  whereby  an  increase  in  the 
neutralizing  substance  was  brought  about.  What  is  the 
source  of  lactose?  It  is  a  sugar  found  only  in  connection 
with  the  secretions  of  the  mammary  glands,  generated  from 
the  stimulus  associated  with  the  pregnant  and  lactation 
periods. 

Further  instances  might  be  supplied  but  the  point  is 
sufficiently  plain.  The  body  organism  by  virtue  of  its  ability 
to  act  upon  and  be  acted  upon  is  continually  meeting  new 
conditions  as  they  arise  and  responding  in  a  manner  which 
insures  its  continued  activity  as  a  separate  and  self-sufficient 
organism  in  a  world  of  contending  organisms  and  inanimate 
forces.  Through  its  chemical  activities,  aided  by  a  favorable 
medium,  it  is  enabled  to  successfully  maintain  an  identity 
given  to  it  by  a  long  line  of  ancestors,  but  at  the  same  time 
permitting  of  sufficient  variation  in  its  less  important  struc- 
tural and  functional  details  to  prevent  disintegration  that 
would  result  were  it  of  a  less  yielding  nature. 


SOME  FUNDAMENTAL  CONSIDERATIONS.  43 


CHAPTER  III 

SOME  FUNDAMENTAL  CONSIDERATIONS.     (CON.) 
THE  ENERGY  OF  THE  BODY. 

The  suggestion  that  man  is  a  machine  gives  rise  to  the 
problem  of  the  nature  and  source  of  the  energy  that  must  of 
necessity  be  associated  with  the  body.  For  one  of  the  char- 
acteristics of  the  machine, whether  it  be  animate  or  inanimate, 
is  its  ability  to  convert  one  form  of  energy  into  another.  So 
far  as  is  at  present  known  no  creation  or  loss  of  energy  is 
possible.  This  law  of  the  conservation  of  energy  is  one 
of  the  most  fundamental  and  significant  of  the  laws  made 
emphatic  during  the  last  century.  It  is  no  less  true  of  the 
living  body  than  of  other  mechanisms  and  other  worlds,  that 
the  various  manifestations  of  motion  are  but  the  different 
forms  into  which  the  one  universal  energy  may  be  changed 
from  time  to  time. 

What  is  energy?  Authorities  differ  in  details,  but  all  are 
agreed  that  energy  may  be  most  nearly  conceived  of  as 
motion.  Dr.  Still  has  emphasized  the  triune  nature  of  the 
body  in  his  discussions  of  "Matter,  Motion  and  Mind."  Mat- 
ter is  inert  in  so  far  as  it  may  be  independent  of  motion.  But 
matter  can  not  be  independent  of  motion  and  manifest  itself 
to  the  senses.  The  two  are  one  and  inseparable.  The  motion 
of  an  atom  is  an  integral  part  of  the  conception  of  an  atom. 
As  soon  as  matter  becomes  separate  from  motion  the  uni- 
verse as  such  must  cease  to  exist.  We  know  that  appear- 
ances are  continually  changing.  We  know  that  change  is  a 
law  of  nature.  And  change  is  only  possible  through  the 
numerous  forms  of  energy  that  are  associated  with  the  sub- 
stance of  which  all  natural  things  are  composed.  We  may 
conceive  of  mass  motion,  and  molecular  motion,  and  atomic 
motion.  These  are  in  all  likelihood  different  phases  of  the 
Same  great  energizing  principle  which  lies  back  of  the  man- 


44  PRINCIPLES   OF   OSTEOPATHY. 

ifestation.     All  are  concerned  with  the  one  inherent  property 
of  all  matter — that  which  we  denominate  energy. 

It  has  been  said  that  energy  remains  the  same  in  essence. 
How  is  it  that  it  appears  so  different  under  different  circum- 
stances? We  are  led  thus  to  a  consideration  of  a  corollary  to 
the  proposition  that  energy  is  never  lost  or  created,  and  that 
is,  that  there  is  a  continual  transformation  of  energy. 
This  capacity  for  transformation  depends  upon  the  circum- 
stances of  the  matter  with  which  the  energy  is  associated. 
Any  mechanism  which  is  able  to  cause  a  new  appearance  in 
the  manifestation  of  energy  is  a  transformer,  not  a  creator  of 
energy.  The  human  body,  as  of  all  living  bodies,  is  such  a 
transformer.  The  proposition  may  be  illustrated  by  several 
instances. 

One  of  the  forms  which  energy  assumes  is  that  of  chem- 
ical action  which  may  be  considered  as  an  attraction  be- 
tween atoms.  It  is  needless  to  more  than  call  attention  to 
the  fact  that  body  functioning  is  largely  dependent  upon  the 
attraction  that  thus  exists.  The  source  of  such  energy  is 
ultimately  from  the  external  world,  i.  e. ,  from  the  food  mate- 
rials taken  into  the  body  and  from  the  potential  capacities  of 
the  living  cells  which  were  transmitted  to  it  from  its  parent- 
age. Of  the  latter  we  are  forced  to  assume  an  inherent  vital- 
ity which  inaugurates  the  various  changes  of  a  chemical  na- 
ture with  which  the  embryological  processes  are  associated. 
Here  we  undoubtedly  have  a  transformation  of  vital  into  chem- 
ical energy.  But  that  added  chemical  energy  further  assists 
vital  activities  in  which  new  vital  energy  is  shown,  and  a  re- 
transformation  appears.  The  food  materials  taken  into  the 
alimentary  canal  represent  immense  quantities  of  stored  chem- 
ical energy.  As  soon  as  this  material  comes  in  contact  with 
certain  other  substances  in  the  canal  which  are  the  product 
of  other  vital  and  chemical  factors,  the  potential  energy  of 
the  food  mass  becomes  kinetic  in  the  liberation  of  new  chem- 
ical action  and  heat.  The  oxygen  taken  into  the  body  through 
the  membrane  of  the  air  cell  passes  into  the  blood,  is  carried 


SOME   FUNDAMENTAL   CONSIDERATIONS.  45 

to  various  parts  of  the  body,  unites  with  the  carbon  of  the 
food  and  of  the  body  tissue  and  in  the  chemical  changes  thus 
initiated,  heat  is  set  fr«e.  In  the  finer" processes  of  assimila- 
tion and  dissimilation  the  same  changes  and  reverse  changes 
are  produced  through  the  continual  interaction  of  chemical 
and  vital  activity. 

There  is  a  cohesive  force  characteristic  of  certain  body 
actions.  This  may  be  spoken  of  as  molecular  attraction. 
Every  molecule  has  an  attraction  or  a  repulsive  effect  on 
every  other  molecule.  This  is  true  whether  the  substance  in 
or  of  the  body  be  solid,  fluid,  or  gas.  The  constant  inter- 
mixing of  the  fluids  of  the  body  in  the  processes  of  diffusion, 
filtration  and  osmosis  represents  but  a  difference  in  the  attrac- 
tions between  the  molecules  of  the  different  substances.  By 
virtue  of  this  action  a  continual  interchange  between  parts  of 
the  body  becomes  possible,  and  considering  the  fact  of  proto- 
plasmic continuity  it  becomes  doubly  significant  as  a  factor 
in  body  metabolism.  The  difference  in  gaseous  pressures  be- 
tween the  oxygen  of  the  air  in  the  alveoli  and  that  in  the 
blood  explains  in  part  the  presence  of  oxygen  in  the  blood. 
Similarly  the  excess  of  the  carbon  dioxid  in  the  blood  with 
reference  to  the  amount  in  the  lung  spaces  provides  a  means 
for  excretion  of  the  noxious  gas.  In  the  process  of  molecular 
action  and  interaction  new  conditions  favorable  to  different 
atomic  affinities  arise  and  we  have  the  molecular  energy 
transformed  into  atomic  energy. 

The  energy  of  gravitation  while  not  apparent  as  such  in 
the  body  is  responsible  for  certain  actions  that  there  take 
place.  We  may  speak  of  this  energy  as  the  attraction  be- 
tween masses  and  while  this  attraction  undoubtedly  exists 
in  the  case  of  different  masses  of  the  body  tissue  it  is  insig- 
nificant as  compared  to  the  attraction  between  the  body  and 
the  earth.  In  this  connection  it  is  interesting  to  note  the  fact 
that  the  urinary  apparatus  of  the  human  body  is  so  situated  as 
to  take  advantage  of  gravitation  and  by  virtue  of  this  fact 
alone  the  kidneys  are  in  large  part  continually  drained  of 


46  PRINCIPLES   OF   OSTEOPATHY. 

their  excretions;  while  in  all  animals  gravitation  is  made  use 
of  in  the  discharge  of  excretions  from  the  body.  Dr.  Still  has 
suggested  the  important  point  that  in  case  of  fever  conditions 
or  other  weakening  states,  the  body  should  be  placed  in  an 
inclined  position  in  order  to  assist,  through  the  energy  of 
gravitation,  the  discharge  of  the  excretions  through  the 
ureters.  Transformations  occur  in  the  interaction  between 
gravitation  energy  and  that  of  other  forms.  Molecular  and 
chemical  movements  occur  in  opposition  to  the  force  of  grav- 
itation with  a  consequent  production  of  new  forms  of  energy 
such  as  heat  and  electric  action. 

The  mechanical  energy  of  pressure  and  friction  and 
change  of  shape  associated  with  the  different  parts  of  the 
same  substance  are  very  manifest  in  the  body  and  in  its  rela- 
tions to  the  external  world.  By  virtue  of  the  continual  move- 
ment of  the  body  parts  and  the  movements  associated  with 
environment  pressures  and  friction  occur  with  the  resulting 
liberation  of  heat  and  other  forms.  The  friction,  of  the  blood 
upon  the  vessel  walls  accounts  to  some  extent  for  the  resist- 
ance to  the  blood  flow  which  is  so  necessary  to  a  normal  blood 
pressure.  This  friction  invariably  produces  additional 
changes  in  form,  and  as  a  result  heat  and  electric  and  chem- 
ical action  appear.  The  mechanical  pressures  of  external 
matter  and  internal  matter  upon  nerve  terminals  and  less  respon- 
sive body  protoplasm,  produces  impulses  which  are  nervous  or 
muscular  in  character,  either  directly  or  through  an  interme- 
diate chemical  energy  which  is  in  turn  converted  into  a  nerve 
impulse.  The  latter  acting  upon  the  stored  materials  in  the 
nerve  cell  body  is  rechanged  into  chemical  and  vital  energy 
which  will  thence  further  the  chain  of  action.  Mechanical 
energy  acting  in  the  nature  of  a  stimulus  is  of  prime  import- 
ance to  the  osteopath.  /  For  it  is  largely  through  the  influence 
of  pressures  that  he  is  able  to  explain  the  various  effects  from 
mechanical  displacements  of  tissues  constituting  the  lesion 
which  is  the  most  important  cause  of  disease. 

In  a  special  kind  of  molecular  movement  is  seen  another 


SOME   FUNDAMENTAL   CONSIDERATIONS.  47 

form  of  energy  with  which  the  body  is  associated  and  which 
is  denominated  thermal  energy.  This  is  spoken  of  as  a 
molecular  vibration,  the  increase  of  which  explains  the  condi- 
tion of  a  rising  temperature,  the  absence  of  which  constitutes 
the  absolute  zero  point.  That  a  certain  heat  level  is  necessary 
to  body  functioning  is  evident  not  only  from  experimental  ob- 
servation but  from  the  known  remarkable  apparatus  present 
in  man  which  maintains  that  level  in  spite  of  a  fluctuating 
temperature  of  the  environment.  The  sources  of  this  form  are 
direct  from  the  external  world  through  the  medium  of  radi- 
ation from  the  sun  and  other  warm  bodies,  or  the  materials 
taken  in  through  the  alimentary  and  respiratory  tracts  in  the 
form  of  warm  food  and  air ;  but  in  large  part  the  heat  energy 
is  indirect  from  a  transformation  of  chemical  energy  the  source 
of  which  we  have  already  indicated.  Practically  every  chem- 
ical action  will  be  associated  with  the  liberation  of  heat, 
although  in  most  anabolic  processes  the  consumption  of  heat 
will  be  in  excess  of  its  liberation.  Of  the  chemical  actions 
concerned  with  the  liberation  of  heat  oxidation  processes  are  by 
far  the  most  important.  The  amount  of  oxygen  consumed  in 
the  course  of  twenty -four  hours  amounts  to  700  grams  or 
about  sixteen  quarts  per  hour.  This  is  suggestive  as  indi- 
cating the  immense  amount  of  oxidation  that  takes  place  in 
the  body.  While  it  is  thus  true  that  the  heat  is  in  large  part 
derived  from  chemical  action  together  with  that  resulting  from 
mechanical  energy  of  friction  and  movement,  it  is  also  true 
that  a  transformation  back  into  chemical  and  mechanical 
energy  takes  place  in  extreme  degree.  One  chemical  change 
liberates  energy  in  the  form  of  heat.  This  heat  by  furnishing 
a  normal  medium  initiates  new  chemical  change  and  is  in  other 
cases  perhaps  converted  directly  into  muscular  and  other 
movement.  Throughout  the  various  metabolic  processes  these 
continual  transformations  are  manifest. 

Photic  energy  is  essential  to  life  processes.  Light  has 
been  defined  for  lack  of  more  definite  knowledge'as  ether  vibra- 
tion. This  vibration  is  ultimately  essential  for  all  life  processes. 


48  PRINCIPLES   OF   OSTEOPATHY. 

The  process  of  formation  of  the  organic  foodstuffs  has  thus 
far  defied  all  laboratory  attempts  and  the  only  source  of  the 
synthesis  of  proteid,  carbohydrate,  and  fat  is  the  cell  of  the 
living  organism.  From  the  plant  the  animal  gets  its  food 
material  ready  made.  But  in  order  that  the  plant  shall  be 
able  to  effect  this  synthesis  light  is  necessary.  Through 
some  power  seemingly  associated  with  the  chlorophyll  bodies 
the  plant  is  enabled  to  utilize  the  ether  vibration  in  the  chem- 
ical processes  concerned  in  the  food  formation  from  inorganic 
materials.  But  it  is  not  alone  in  this  indirect  way  that  light  is 
essential  to  animal  life,  for  observation  shows  that  individuals 
living  in  an  environment  of  greater  or  less  deprivation  of  Irght 
become  abnormal  in  their  functioning.  This  fact  suggests 
the  necessity  for  looking  to  the  environment  of  the  individual 
for  the  preservation  of  normal  health.  From  this  fact  has 
arisen  the  light  cure  by  which  it  was  hoped  to  overcome  disease 
conditions  through  an  excess  of  the  energy,  a  certain  amount 
of  which  is  essential.  An  excess  of  any  force  or  factor  is  never 
logical  o.s  a  method  of  cure.  That  an  excess  of  light  is  deleter- 
ious there  is  sufficient  evidence  to  show.  Ordinary  sunburn 
in  fair-skinned  individuals  is  a  pathologic  condition  as  also 
are  the  burns  from  X-ray  applications.  Individuals  working 
in  factories  where  light  is  generated  or  in  other  conditions 
where  an  excess  of  light  is  present  suffer  from  various  forms 
of  cutaneous  and  other  disorders.  Light  is  further  a  normal 
stimulus  for  the  function  of  sight.  In  this  case  the  ether  vibra- 
tion coming  into  relation  with  the  pigmentary  layer  of  the 
retina  is  transformed  into  chemical  energy  which  influences 
nerve  terminals  and  which  in  turn  results  in  the  definite  sub- 
jective sensation.  Whether  in  the  human  body  light  is  pro- 
duced from  transformation  of  other  known  forma  remains  to 
be  proven.  In  the  case  of  certain  of  the  lower  and  especially 
the  marine  animals,  chemical  action  or  other  energy  is  quite 
appreciably  transformed  into  light. 

Ether  stress  or   electric  energy  is  undoubtedly  asso- 
ciated with  a  large  number  of  body  processes.     In  the  exper- 


SOME   FUNDAMENTAL   CONSIDERATIONS.  49 

imental  laboratory  i-t  can  be  shown  that  both  chemical  and 
mechanical  energy  may  be  transformed  into  electricity.  It 
is  probable  that  similar  conditions  in  the  case  of  the  living 
organism  are  responsible  for  the  electrical  .manifestations 
known  to  be  present.  It  is  known  that  in  conditions  of  activ- 
ity and  of  pathology  a  difference  of  electric  potential  exists  in 
muscle  such  that  the  active  and  the  resting  state  are  electric- 
ally opposite  in  sign,  which  is  also  true  of  the  normal  and  the 
injured  tissue.  Undoubtedly  the  chemical  stress  in  these 
various  states  are  different  and  hence  a  difference  in  elec- 
tric stress  is  entirely  reasonable.  This  becomes  of  special 
interest  in  view  of  the  recent  investigations  into  electro -chem- 
istry which  tend  to  show  a  marked  similarity  between  chem- 
ical and  electric  action,  if  not  an  actual  identity.  The  in- 
vestigation into  the  electric  conditions  of  the  body  has  only 
begun  and  the  further  results  are  awaited  with  much  interest. 
Dr.  Still  continually  assumes  the  presence  in  normal  as  well 
as  abnormal  conditions,  of  a  force  of  an  electric  or  magnetic 
nature,  and  no  demonstration  to  the  contrary  has  yet  shown 
that  he  is  wrong,  while  what  experimental  evidence  is  avail- 
able suggests  that  he  is  correct.  The  fact  that  such  "cur- 
rents" exist  has  given  rise  to  numerous  attempts  to  make  use 
of  the  fact  in  a  therapeutic  way,  but  thus  far  electrotherapy 
has  proven  as  unsatisfactory  as  has  the  drug,  and  for  the 
reason  that  the  form  of  electricity  present  in  living  organisms 
is  a  special  product  of  the  particular  organism. 

With  reference  to  nerve  energy  little  can  be  said.  Its 
fundamental  importance  is  obvious  and  will  be  continually 
referred  to.  What  it  is  we  know  not.  It  may  be  measured  in 
its  rapidity,  it  may  be  judged  by  its  effect.  Whether  it  be 
electrical  or  chemical  or  neither  we  can  not  at  present  say. 
Suffice  it  to  note  that  it  results  from  transformations  of  all 
other  kinds,  and  in  turn  may  be  converted  into  numerous 
forms.  Mechanical  force,  chemical  action,  light— all  may 
influence  its  action  and  assist  in  co-ordinating  its  impulses. 
It  is  unique  among  the  body  forces  and  to  the  osteopath 


50 


PRINCIPLES   OF   OSTEOPATHY. 


represents  a  most  interesting  field  of  study.  When  its  ulti- 
mate nature  is  once  known  and  its  manifestations  and  varia- 
tions understood,  much  will  be  done  toward  explaining  the 
numerous  facts  of  body  functioning  and  a  long  stride  will 
have  been  taken  toward  the  solution  of  many  vexed  problems 
in  osteopathic  practice. 

In  connection  with  the  above  considerations  the  following 
table  modified  from  Hall's  Physiology  is  suggestive.  Note 
that  the  energy  of  the  body  finally  is  given  off  largely  if  not 
entirely  in  the  form  of  heat.  Owing  to  the  fact  that  the  lat- 
ter is  fairly  subject  to  measurement,  approximations  of 
energy  expenditure  can  easily  be  determined: 

BALANCE  SHEET  OF  ENERGY  FOR  MAN  AT  LIGHT  WORK. 


Inc.  in  Cal. 

Exp.  in  Cal. 

Proteids  :  110  grams  at  4000  calories 
Fats:          100       "      "  9400 
Carboh:     400       "      "  4180 
Expenditure 
Mechanical  work  reduced  to  calories 
Excreta  loss  (1900  grams)  

440,000 
940,000 
1,672,000 

500,000 
47,500 

Warming  of  inspired  air  

84,500 

Evaporating  660  grams  perspiration 
330    "  H2O  from  lungs 
Radiation  and  conduction  from  skin 

384,120 
192,600 
1,843,280 

3,052,000 

3,052,000 

Thus  far  the  fact  has  been  emphasized  that  energy  in 
various  forms  is  fundamental  in  the  life  processes.  It  should 
be  understood  that  in  any  form  of  energy  it  may  exist  either 
as  potential  or  kinetic,  i.  e.,  as  latent  or  active,  and  that 
these  are  changeable.  The  combination  of  the  molecules  and 
atoms  in  foodstuffs  represents  potential  atomic  and  molecular 
energy,  which,  on  coming  into  relation  with  certain  environ- 
ments furnished  by  the  body,  is  converted  into  the  kinetic 


-.'  GF 
. CGLLEG 

c'tfhs 

SOME   FUNDAMENTAL   CONSIDERATIONS.  51 

energy  of  chemical  action  and  heat.  The  free  molecule  of 
oxygen  in  the  plasma  of  the  blood,  by  virtue  of  its  chemical 
affinities  has  potentially  the  power  to  unite  with  carbon  and 
other  elements  and  substances  with  the  transformation  into 
the  kinetic  energy  of  chemical  action  and  liberation  of.  heat. 
The  stored  protoplasm  in  muscle  substance  represents  poten- 
tially the  activity  that  becomes  manifest  as  mechanical 
energy  on  the  application  of  a  stimulus.  The  stretched  con- 
dition of  the  aortic  ivall  immediately  following  the  systolic 
discharge  is  potential  energy  which  immediately  becomes 
active  in  a  recoil  through  its  elastic  property. 

Summarizing  the  foregoing  and  making  a  definite 
application  we  may  make  the  general  proposition  that  a  nor- 
mal condition  of  health  is  dependent  on  a  proper  co-ordination  of 
energies,  and  that  disease  represents  a  state  of  living  matter 
such  that  inco- ordination  results.  If  the  condition  of  muscle 
tissue  is  such  that  its  potential  energy  requires  an  excess  of 
stimuli  to  be  converted  into  a  kinetic  manifestation,  then  ab- 
normality exists.  If  a  nerve  cell  body  is  in  a  condition  of  hy- 
per-excitability, due  to  disorders  of  its  nutrition,  the  condi- 
tion is  a  too  ready  response  to  a  stimulus  with  resulting  change 
to  a  kinetic  form.  Further,  these  transformations  all  represent 
normal  stimuli  to  body  action.  Life  processes  consist  largely  of 
response  to  the  stimuli  of  a  continuous  stream  of  impulses 
that  pass  by  the  millions  of  afferent  tracts  from  periphery  to 
center.  If  the  external  or  environmental  changes  are  too 
rapid  or  intense  for  a  normal  response,  or  the  organism  is  in 
a  condition  which  prevents  a  sufficiently  rapid  assimilation 
of  energy  and  its  proper  conversion,  disorder  must  result.  In 
the  former  the  fault  lies  with  the  environment  and  is  a  cause 
of  disease  which  we  have  in  another  section  classified  as  an 
abuse  of  function.  In  the  latter  the  condition  will  usually  be 
found  dependent  on  a  condition  of  impaired  structure  which 
modifies  the  processes  necessary  to  a  proper  co-ordination  of 
energies.  When  through  lesion  to  the  digestive  apparatus  a 
deficiency  of  gastric  secretion  exists  the  balance  between  the 


c 


PRINCIPLES   OF   OSTEOPATHY. 


potential  energy  of  the  food  and  that  of  the  gastric  juices  is 
disturbed.  Hence  disturbed  chemical  transformation  results. 
Through  a  fault  of  the  organic  structure  the  heat  re 


FIG.  3. — Illustrating  income,  interchange  and  output  of  energy  of  the  body. 

mechanism  becomes  deranged  and  an  excessive  chemical  action 
with  heat  liberation  results  with  a  consequent  rise  in  body 
temperature.  This  rise  in  temperature  furnishes  the  occa- 
sion for  further  excessive  transformations  and  a  chain  of 
effects  follow.  An  injury  to  a  muscle  initiates  chemical  changes 
excessive  in  kind  or  degree,  and  a  considerable  difference  in 


SOME   FUNDAMENTAL   CONSIDERATIONS.  53 

electric  potential  is  produced.  The  electric  action  then  is 
re-converted  into  chemical  and  heat  energies  and  inflamma- 
tory conditions  result.  The  continued  absence  of  any  normal 
stimulus  from  environmental  change,  such  as  light,  results  in 
a  loss  of  energy  transformation  which  is  dependent  upon 
such  stimulus,  and  a  general  weakness  is  a  consequence. 

With  the  action  and  interaction  of  matter  and  motion, 
then,  and  all  under  the  superintendency  of  a  guiding  force, 
call  it  mind,  vitality  or  whatnot,  the  normal  body  metabolism 
will  be  maintained  in  harmony  with  itself  and  with  its  environ- 
ments. Through  long  ages  the  organism  has  been  subjected 
to  certain  environmental  conditions  by  which  it  has  become 
adapted  to  ordinary  and  to  numerous  extraordinary  circum- 
stances. In  such  adaptations  of  energy  we  have  the  most 
remarkable  fact  of  living  tissue. 

BODY  F.UEL. 

The  principal  source  of  the  energy  of  the  organism  is  the 
food  materials.  It  is  manifest  that  for  a  proper  transforma- 
tion and  utilization  of  energy  there  must  be  a  sufficient  quan- 
tity and  quality  of  the  food  to  be  disintegrated  to  yield  the 
necessary  forms.  As  an  engineer  insists  on  a  good  quality 
of  the  fuel  as  a  prerequisite  to  a  full  capacity  in  the  perform- 
ance of  his  engine,  so  the  human  engine  must  be  supplied 
with  materials  appropriate  to  its  needs.  From  analysis  of 
body  substance  and  from  experimental  observation  it  has 
been  determined  that  there  are  certain  organic  and  inorganic 
materials  which  are  essential  to  normal  body  functioning. 
Among  the  former  we  note  proteids,  carbohydrates  and  /ate; 
among  the  latter,  water  and  several  salts,  more  especially 
sodium  chloride.  Numerous  other  salts  are  found  in  body 
tissues  but  are  present  in  sufficient  abundance  in  the  organic 
foodstuffs  to  make  it  unnecessary  to  supply  additional  mate- 
rial. Indeed  evidence  is  accumulating  to  show  that  except  in 
the  form  of  these  complex  organic  substances,  they  will  not 
be  assimilated.  The  function  ot  the  various  inorganic  salts  is 


54  PRINCIPLES   OF  OSTEOPATHY. 

in  large  part  the  regulation  of  the  medium  in  which  organic 
foods  may  be  stored,  transported  and  assimilated.  Thus 
Thompson  suggests  the  following  functions:  "To  regulate 
the  specific  gravity  of  the  blood  and  other  fluids  of  the  body; 
to  regulate  the  chemical  reaction  of  the  blood  and  the  various 
secretions  and  excretions;  to  preserve  the  tissues  from  dis- 
organization and  putrefaction ;  to  control  the  rate  of  absorption 
by  osmosis;  to  enter  into  the  permanent  composition  of  cer- 
tain structures,  especially  the  bones  and  teeth;  to  enable  the 
blood  to  hold  certain  materials  in  solution ;  to  serve  special 
purposes,  such,  for  example,  as  the  influence  of  sodium  chlo- 
ride on  the  formation  of  hydrochloric  acid,  and  that  of  lime 
salts  in  favoring  coagulation  of  the  blood."  Water  is  an  ab- 
solute essential  and  must  be  taken  in  greater  quantity  than 
is  present  in  the  ordinary  diet.  Its  functions  are  largely 
secondary  to  those  of  the  organic  foods  but  none  the  less  es- 
sential. The  very  fact  that  sixty  percent  of  the  body  is  water 
indicates  its  great  value.  We  have  referred  to  the  fact  that 
the  essential  life  substance — protoplasm— is  largely  fluid  and 
for  specific  purposes.  This  fluidity  is  dependent  on  the  pres- 
ence of  water.  We  may  enumerate  the  following  as  the  more 
important  uses  of  water  to  the  body  organism :  solvent,  diluent, 
medium  for  transportation,  stimu)ant,and  a  thermolytic  agent. 
Unquestionably  there  are  individuals  who  take  less  water  than 
is  essential  to  a  normal  functional  and  structural  condition. 
Proteids  are  the  most  essential  of  the  organic  substances.  It 
has  been  shown  by  Pfluger  and  others  that  in  case  of  the  dog, 
of  the  organic  foods  proteid  alone  is  sufficient  to  maintain  life, 
while  the  absence  of  proteid  material  in  the  food  is  immedi- 
ately disastrous  to  normal  function  and  soon  results  in  death. 
In  general  the  statement  is  true  that  proteids  are  the  tissue 
builders  while  the  carbohydrates  and  fats  are  energy  producers, 
i.  e.,  are  oxidized  with  the  liberation  of  heat.  In  the  absence 
or  deficiency  of  the  latter  two  proteid  may  be  converted  into 
sugars  and  fats. 

With  the  finer  processes  of  metabolism  we  are  of  ne- 


SOME   FUNDAMENTAL   CONSIDERATIONS.  55 

cessity  much  in  ignorance.  "What  takes  place  in  the  trans- 
formation from  non-living  to  living  proteid  we  cannot  know 
except  in  the  more  gross  details.  We  know  this,that  only  those 
substances  which  are  concerned  with  tissue  building,  secre- 
tion, and  energy  transformation  will  be  permitted  to  remain 
in  association  with  the  living  protoplasm.  In  this  connection 
Dr.  C.  M.  T.  Hulett  has  emphasized  the  fundamental  fact 
when  he  says,  "The  chain  of  events  in  metabolism  is  a 
closed  chain  and  into  this  metabolic  cycle  no  substances  but 
those  that  serve  as  food  can  ever  enter.  Material  not  suit- 
able for  its  upbuilding  cannot  be  imposed  upon  living  sub- 
stance. It  will  take  in  only  food  elements  and  only  such 
quantity  of  those  as  its  needs  determine,  without  regard  to 
the  supply  which  might  be  available.  The  only  way  in  which 
other  substances,  e.  g.  drugs,  can  become  incorporated  with 
living  substance  is  by  destroying  it.  Acids  and  poisons  unite 
with  it  in  that  way.  The  constituent  events  of  the  metabolic 
cycle  do  not  follow  each  other  in  a  single  line  but  in  many 
lines.  Pfluger  has  emphasized  the  importance  of  the  poly- 
merization of  the  proteid  molecule  in  growth — assimilation, 
in  living  substance,  in  which  the  simple  molecule  takes  in 
from  the  materials  of  the  environment  atoms  of  food  elements 
attaching  them  to  itself  until  it  becomes  a  polymeric  mole- 
cule. It  then  breaks  down  into  simple  molecules,  each  of 
which  repeats  the  process  for  itself,  again  and  again,  form- 
ing in  that  way  numbers  of  chains  of  many  similar  links. 
Dissimilation  is  the  reverse  of  this  process,  the  end  products 
being  principally  water,  carbon  dioxide,  and  urea.  The  suc- 
cessive chemical  reactions  in  each  chain  or  line  have  been 
compared  to  explosions  on  account  of  the  great  lability  of 
the  compounds."  (Journal  of  the  American  Osteopathic  As- 
sociation, Nov.  1901).  By  the  process  of  selection  which  is  a 
characteristic  attribute  of  living  protoplasm,  every  particle  of 
the  latter  and  every  cell  takes  or  rejects  the  materials  fur- 
nished to  it  by  the  blood  or  lymph.  In  a  similar  manner  it 
throws  out  from  its  substance  into  the  blood  or  lymph  every 


56  PRINCIPLES   OF   OSTEOPAHTY. 

material  that  is  of  no  further  use  to  its  functioning.  This  is 
true  of  the  substances  that  are  formed  from  cell  katabolism  but 
is  equally  true  of  those  foreign  elements  which  have  tempor- 
arily gained  access  to  the  protoplasmic  substance.  In  order 
that  the  two  processes — selection  of  food  materials  and  re- 
jection of  waste — may  be  exactly  balanced  the  medium  for  trans- 
portation must  be  normal  in  kind  and  quantity.  The  lymph 
must  contain  a  sufficient  available  material  from  which  the 
cell  may  select  and  must  be  in  sufficiently  normal  condition  of 
osmotic  pressure  and  chemical  condition  as  to  offer  no  serious 
hindrance  to  the  exchange  of  waste  for  nutrition.  This  man- 
ifestly will  depend  on  a  normal  condition  of  the  blood  both 
with  reference  to  quantity  and  quality.  Since  the  latter  is  en- 
tirely dependent  on  a  proper  proportion  of  organic  and  in- 
organic substances  the  necessity  for  a  proper  food  supply 
becomes  at  once  apparent. 

It  does  not  follow  from  the  above  considerations  that 
every  change  in  the  dietary  conditions  will  immediately  or 
remotely  produce  a  disturbance  in  the  protoplasmic  exchange. 
For,  note  that  there  are  large  possibilities  of  reserve  sup- 
plies between  the  cell  and  the  digestive  tract.  The  cell 
itself  is  capable  of  carrying  on  its  functioning  for  an  appre- 
ciable time  even  though  the  blood  be  totally  removed.  This 
is  true  because  it  is  a  function  of  the  cell  to  store  an  excess  of 
food  not  immediately  needed.  In  every  cell  under  ordinary 
conditions  there  are  fat  droplets,  glycogen,  and  other  reserves 
which  in  addition  to  its  own  substance  will  be  drawn  upon  as 
the  needs  require.  In  the  lymph  and  blood  and  in  the  inter- 
cellular tissues  there  are  immense  quantities  of  stored  material. 
This  explains  the  fact  that  the  organism  may  fast  for  weeks 
with  little  impairment  of  function  though  there  will  be  an 
appreciable  loss  of  substance  which  is  in  large  part  not  im- 
mediately essential  for  proper  activity. 

What  are  the  essentials  in  a  diet?  The  science  of  dietetics 
is  still  in  a  condition  of  chaos.  Analysis  of  the  body  tissues 
and  excretions  have  thrown  some  light  on  the  problem. 


SOME   FUNDAMENTAL   CONSIDERATIONS.  57 

Note  this  fact:  the  chemical  composition  of  a  foodstuff  is  not  a 
sufficient  criterion  for  judgment  as  to  its  value  to  the  organism.  If 
this  were  the  case  the  food  supply  of  the  world  would  become 
a  question  of  laboratory  synthesis.  The  various  elements 
must  be  in  a  definite  condition  of  combination.  Further,  not 
all  combinations  seemingly  alike  in  their  various  character- 
istics are  equally  available  to  the  organism.  Starch  and  cel- 
lulose are  similar  in  composition  but  the  latter  is  nearly  indi- 
gestible. Various  of  the  prepared  foods,  while  containing  all 
the  elements  and  compounds  in  proper  proportion,  have  been 
found  deficient  in  their  nutritive  power.  The  condensed 
foods,  pepsinized  and  otherwise  pre- digested  foods,  are  not 
suitable  for  ordinary  conditions.  The  decrying  of  white  flour 
and  extolling  the  whole  wheat  variety  was  the  fashion  among 
the  dietarians  a  few  years  back.  Chemical  analysis  showed 
that  the  whole  wheat  contained  the  essential  organic  food- 
stuffs in  more  nearly  a  correct  proportion  than  did  the  white. 
Yet  analysis  of  the  f eces  shows  that  the  proteids  in  the  husks 
and  outer  part  is  much  less  available  and  hence  in  large 
part  of  no  use  to  the  organism  except  as  a  stimulant  to 
peristalsis. 

With  the  average  diet  available  to  the  ordinary  Amer- 
ican the  organism  is  amply  able  to  extract  sufficient  of  the 
nutritive  principles  to  maintain  body  vigor.  Statistics 
with  reference  to  different  people  and  different  climates  are 
illuminating  more  in  that  they  show  that  what  is  chemically 
a  very  deficient  diet  is  actually  and  physiologically  a  very 
sufficient  one.  The  Esquimaux  with  his  tallow  and  the 
Chinaman  with  his  rice  do  not  show  sufficient  difference  ex- 
plainable alone  from  dietetic  conditions, to  make  it  a  safe  rule 
to  rely  upon  chemical  analysis  alone  for  judgment  of  food 
values. 

In  connection  with  the  above  Professor  Atwater  saya  in 
"Principles  of  Nutrition  and  Nutritive  Value  of  Foods,"  a 
bulletin  published  by  the  United  States  Department  of  Agri- 
culture: "Digestibility  is  often  confused  with  another  very 

0 


58  PRINCIPLES   OF   OSTEOPATHY. 

different  thing,  namely,  the  agreeing  or  disagreeing  of  food 
with  the  person  who  eats  it.  During  the  process  of  diges- 
tion and  assimilation  the  food  as  we  have  seen,  undergoes 
many  chemical  changes,  some  of  them  in  the  intestines,  some 
in  the  liver,  muscles,  and  other  organs.  In  these  changes 
chemical  compounds  may  be  formed  which  are  in  one  way  or 
another  unpleasant  and  injurious,  especially  if  they  are  not 
broken  down  (as  normally  they  are)  before  they  have  oppor- 
tunity thus  to  act.  Some  of  the  compounds  produced  from 
the  foods  in  the  body  may  be  actually  poisonous. 

Different  persons  are  differently  constituted  with  respect 
to  the  chemical  changes  which  their  food  undergoes  and  the 
effect  produced,  so  that  ic  may  be  literally  true  that  'one 
man's  meat  is  another  man's  poison.'  Milk  is  for  most 
people  a  very  wholesome,  digestible  and  nutritious  food,  but 
there  are  persons  who  are  made  ill  by  drinking  it,  and  they 
should  avoid  milk.  The  writer  knows  a  boy  who  is  made 
seriously  ill  by  eating  eggs.  A  small  piece  of  sweet  cake  in 
which  eggs  have  been  used  will  cause  him  serious  trouble. 
The  sickness  is  nature's  evidence  that  eggs  are  for  him  an 
unfit  article  of  food.  Some  persons  have  to  avoid  straw- 
berries. Indeed,  cases  in  which  the  most  wholesome  kinds 
of  food  are  hurtful  to  individual  persons  are,  unfortunately 
numerous.  Every  one  must  learn  from  his  own  experience 
what  food  agrees  with  him  and  what  does  not." 

The  time  for  dining  or  the  frequency  do  not  exercise  as 
great  an  influence  upon  body  conditions  as  we  are  led  to 
think  by  numerous  of  the  so-called  "health"  journals.  True 
one  may  dine  so  often  as  to  prevent  recuperation  between 
the  periods  of  activity  of  the  digestive  apparatus.  A  fre- 
quency associated  with  a  small  amount  at  each  period  is  not 
necessarily  bad  practice.  Overloading  under  any  circum- 
stances is  objectionable.  An  abrupt  change  in  dietetic  habits 
is  of  more  importance  as  a  cause  of  digestive  trouble  than  is 
the  particular  habit  of  the  individual. 

With  disease   conditions  present  the  viewpoint     is- 


SOME  FUNDAMENTAL   CONSIDERATIONS.  59 

somewhat  changed.  Yet  we  are  largely  in  the  dark  with 
reference  to  the  dietetic  principle3  to  be  employed  in  partic- 
ular cases.  In  most  cases  appetite  is  a  safe  guide  in  health 
and  within  limits  it  is  true  in  disease.  Very  few  cases  pre- 
sent themselves  when  it  is  advisable  to  force  an  individual  to 
eat  against  his  own  desire.  "Just  a  little  to  keep  up  strength" 
is  advice  and  practice  which  is  accountable  for  numerous 
prolonged  disorders.  The  body  needs  house-cleaning.  It  is 
not  the  part  of  wisdom  to  bring  in  new  furniture  till  the  old  is 
cleaned  and  re-arranged.  The  patient's  desire  will  usually 
indicate  the  time.  But  it  is  equally  faulty  logic  to  withhold 
nourishment  long  after  the  appetite  has  returned.  Fasting  for 
ten,  twenty,  thirty  days  is  advocated  by  various  physicians, 
osteopaths  and  others,  who  rejoice  in  the  reputation  of  follow- 
ing all  methods  of  treatment  that  are  natural !  Excesses  are 
always  unnatural.  The  individual,  as  in  other  unusual  condi- 
tions, may  get  well,  but  the  result  is  only  another  of  the  indi- 
cations that  the  organism  may  regulate  its  function  even 
under  adverse  circumstances. 

MORE  THAN  A  MACHINE. 

While  it  is  necessary  to  make  emphatic  the  fact  that  man 
is  machine-like  in  his  structure  and  operations  it  must  not  be 
forgotten  that  he  is  far  more  than  a  machine  in  the  usual 
sense  of  that  word.  More,  in  the  fact  that  the  body  is  a  self- 
feeding,  self-oiling,  self-operating  and  self-regulating  machine.  Ac- 
count for  that  fact  in  whatever  way  we  can  the  fact  stands 
undisputed.  "Whether  it  be  by  virtue  of  special  physical  and 
chemical  laws  not  yet  understood  or  whether  it  be  through 
the  activity  of  a  special  vital  force  need  not  so  much  concern 
us  at  this  time  since  the  proof  of  either  contention  will  not 
alter  the  fundamentals  of  our  position.  That  force,  whatever 
it  may  be,  initiates,  co-ordinates,  and  controls,  in  the  most  aston- 
ishing manner,  the  various  activities  of  the  body  mechanism, 
enabling  it  to  perform  the  greatest  labor  with  the  least  loss  of 


60  PRINCIPLES   OP  OSTEOPATHY. 

energy — being  far  more  efficient  in  this  respect  than  the  most 
efficient  of  inanimate  machines. 

THE  SELF-SUFFICIENCY  OF  THE  ORGANISM. 

By  virtue  of  the  facts  emphasized  above  the  body  organ- 
ism is  enabled  to  care  for  itself  to  a  remarkable  degree  so  long 
as  it  is  supplied  with  normal  diet.  The  importance  of  this 
idea  is  such  that  we  shall  consider  ti  at  some  length.  If  it 
were  asked  what  fact  is  most  striking  and  most  fundamental 
In  theosteopathic  philosophy,  we  should  unhesitatingly  affirm, 
the  self -regulating  power  inherent  in  bioplasm.  At  the 
outset  it  must  be  noted  that  the  organism's  power  of  self -pro- 
jection is  not  unlimited.  While  from  one  viewpoint  it  is  pref- 
erable to  consider  all  things  as  co-operating  for  the  ultimate 
good  to  each  other  rather  than  as  a  life -and- death  struggle  for 
existence,  yet  the  latter  condition  undoubtedly  does  represent 
one  of  the  tendencies  of  all  nature.  Hence  it  is  presumptuous, 
in  view  of  known  facts,  to  assume  that  thebody  organism  will 
triumph  in  all  its  encounters.  But  the  fact  that  it  is  sufficient 
for  ordinary  conditions  of  environment  and  for  numerous  and 
extreme  emergency  conditions  may  be  emphasized  by  a  few 
illustrations. 

1.  It  is  self-sufficient  functionally  in  health.  Note 
an  illustration  in  the  mechanism  of  circulation :  the  stomach  on 
the  ingestion  of  food  needs  an  increase  of  blood.  The  food 
materials  act  as  a  stimulus  to  certain  nerve  terminals  in  the 
gastric  mucosa;  afferent  impulses  are  sent  to  a  nerve  center 
in  the  sympathetic  ganglia  or  spinal  cord  where  efferent  im- 
pulses are  generated  resulting  in  a  dilatation  of  the  gastric 
arterioles;  the  general  blood  pressure  remaining  unaltered  an 
increased  blood  flow  to  the  stomach  is  inevitable.  In  respira- 
tion :  by  reason  of  an  increase  in  metabolism,  an  excess  of 
carbon  dioxid  is  generated  and  modifies  the  normal  condition 
of  the  blood ;  that  excess  acts  as  a  stimulant  to  certain  nerve 
cells  located  in  the  medulla;  these  generating  efferent  impulses 
over  the  nerves  controlling  the  respiratory  apparatus  cause 


SOME   FUNDAMENTAL   CONSIDERATIONS. 


61 


an  increased  activity  of  that  mechanism  whereby);  the  excess 
of  carbon  dioxid  is  eliminated.  In  heat  regulation  (thermotax- 
is) :  the  individual  is  exposed  to  a  sudden  lowered  external* 
temperature;  by  nerve  influence  and  direct  effect  superficial 
vaso- constriction  and  deep  vaso-dilatation  occur;  hence  not, 
only  a  lessened  opportunity  for  heat  loss,  but  through  several* 
media  an  increased  metabolism  results,  which  means  the 
maintenance  of  the  average  body  temperature  withiri  narrow 
CENTER  IN  limits.  In  vomiting  we  have  an 
^MEDULLA  example  of  emergency  function  ex- 
emplifying  self -regulation ;  an  ir- 
ritating substance  is  taken  into 
the  stomach! which,  acting  as  an 
intense  stimulus  on  terminals  of 
the  vagus  nerve,  cause  afferent 
impulses  to  pass  to  the  so-called 
vomiting  center  in  the  medulla; 
efferent  impulses  sent  out  over 
the  vagus,  the  lower  intercostals, 
and  the  phrenic,  cause  a  forcible 
expulsion  of  the  irritating  mate- 
rials, at  the  ;  same  time  through 
other  mechanisms  the  orifices  of 
the  stomach  are  co-ordinated,  the 
glottis  closed  and  anti-peristalsis 
of  the  esophagus  occurs.  In  the 
depressor  nerve  another  emergency 
function  is  provided  for;  under 
ism  of  vomiting.  ordinary  conditions  of  blood  pres- 

sure that  nerve  is  inactive.  When  by  reason  of  increased 
peripheral  resistance  or  other  cause  the  pressure  becomes  ex- 
cessive terminals  of  the  nerve  in  the  walls  of  the  ventricle 
are  stimulated,  afferent  impulses  are  sent  to  the  vaso -motor 
center  and  general  and  special  dilatation  occurs  with  a  con- 
sequent lowering  of  pressure. 

But  also  in  disease  conditions  we  note  the  regulation. 


FIG.   4. — Illustrating    the   mechan- 


'62  PRINCIPLES    OF   OSTEOPATHY. 

In  the  high  temperature  of  the  body  we  have  a  condition  un- 
favorable to  the  development  of  micro-organisms  which  are 
known  to  be  associated  with  various  fever  states ;  that  high 
temperature  is  brought  about  by  the  disturbed  condition  of 
the  body,  i.  e.,  toxicity,  excess  of  waste,  etc.,  which  acts  as  a 
stimulus  to  an  excessive  metabolism  resulting  in  the  over- 
active  oxidation,  the  heat  thus  generated  acting  not  only  in 
the  manner  suggested  above  but  assisting  in  ridding  the  body 
of  foreign  and  waste  material  by  "burning"  it.  In  convul- 
sions, according  to  Dr.  Still  (See  Philosophy  of  Osteopathy) 
is  represented  an  effort  to  overcome  a  disturbance  in  the 
equilibrium  of  certain  of  the  vital  forces.  The  increased  activity 
of  the  skin  in  disturbed  renal  conditions  represents  an  emer- 
gency function  as  well  as  an  example  of  the  substitution  power 
of  the  body  organs.  In  infection  the  white  blood  corpuscles 
are  increased  in  number  and  efficiency  as  a  result  of  some 
stimulus  dependent  on  the  presence  of  pathogenic  bacteria; 
while  in  addition  to  this  function  of  phagocytosis  of  the  white 
blood  cell  an  increased  antitoxic  condition  of  the  blood  and 
tissues  is  produced  dependent  on  the  same  factors.  In  starv- 
ation, the  body  is  preserved  in  a  remarkable  manner,  for  not 
only  are  stored  foods — glycogen,  fat,  etc. — first  drawn  upon, 
but  when  this  source  of  supply  becomes  exhausted  the  organs 
least  essential  suffer  first.  The  following  table  from  Stewart's 
Physiology,  giving  percentages  of  total  organ  weight  lost  in 
starvation  is  extremely  suggestive : 

Brain 3  Kidneys 26 

Heart 3  Blood 27 

Bones 14  Muscles 31 

Pancreas 17  Testes 40 

Intestines 18  Liver 54 

Lungs 18  Spleen 67 

Skin 21  Fat 97 

2.     It  is  self -sufficient  structurally.     Note  the  calloused 
condition  of  the  palms  in  the  case  of  an   individual  who  per- 


SOME  FUNDAMENTAL  CONSIDERATIONS.  63 

forms  much  manual  labor;  or  the  similar  hardening  of  the 
gums  of  those  who  are  without  teeth — i.  e.,  structural  change 
because  of  functional  increase.  The  body  is  continually 
meeting  with  mechanical  forces  sufficient  to  temporarily  dis- 
place parts,  e.  g. ,  the  ribs,  in  which  the  normal  tension  of 
muscle  and  ligament  is  usually  sufficient  to  re-adjust.  In 
case  of  slight  wounds  blood  and  lymph  together  are  able  to 
approximate  the  parts  and  healing  results. 

But  also  in  disease  the  regulating  power  over  structure 
is  manifested.  On  the  structural  change  in  the  semi- lunar 
valves  permitting  a  regurgitation  of  blood,  the  ventricular 
muscle  hypertrophies  to  correspond  to  the  increased  work  to  be 
done;  in  which  case  we  have  a  compensatory  structural 
change.  In  dislocation  of  hip  where  tension  of  ligaments  and 
muscular  effort  are  insufficient  to  accomplish  reduction,  com- 
pensatory changes  occur,  such  as  shortening  and  lengthen- 
ing of  muscles,  formation  of  new  acetabulum  with  adhesions 
for  ligaments.  In  broken  bones  where  continual  motion  has 
prevented  the  "knitting"  process,  "false  joints"  have  been 
formed  with  all  the  essential  structures,  i.  e.,  articular  sur- 
faces,ligaments  and  synovial  membranes.  In  local  dilatation  of 
the  upper  intestine  in  case  of  absence  of  the  stomach,  and  in 
the  remarkable  case  referred  to  by  Spencer  where,  as  a  result 
of  partial  obstruction  at  the  cardiac  orifice  of  the  stomach, 
food  material  collecting  in  the  lower  part  of  the  esophagus 
initiated  processes  resulting  in  a  dilatation  of  the  canal,  the 
development  of  glands,and  a  crude  form  of  gastric  digestion, 
we  have  illuminating  instances  of  the  ability  of  the  organism 
to  rise  to  the  occasion. 

The  above  facts  have  been  emphasized  for  the  purpose 
of  impressing  the  fundamental  proposition  that  all  pro- 
cesses of  healing  are  dependent  on  the  inherent  power  of  protoplasm; 
that  that  inherent  power  to  heal  will  be  exercised  so  long  as  struct- 
ural conditions  are  normal,  and  in  the  vast  majority  of  cases 
where  the  structural  conditions  are  abnormal,  adjustment  of 
the  latter  are  not  beyond  its  power;  that  the  duty  of  the 


64  PRINCIPLES    OF   OSTEOPATHY. 

physician  is  only  to  keep  external  things — things   external   to 
function — favorable  to  the  exercising  of  that  power. 

THE  TENDENCY  TO  THE  NORMAL. 

The  considerations  in  the  last  section  are  partly  explana- 
tory of  but  more  properly  lead  up  to  a  more  definite  determin- 
ation as  to  the  nature  of  a  normal  condition  and  the  rea- 
sons for  such  a  tendency  to  continually  maintain  or  restore 
that  condition.  If  the  question  were  asked  as  to  what  con- 
stitutes a  normal  condition  few  there  are  who  would  not  be 
able  to  give  a  fairly  satisfactory  answer  in  general  terms.  But 
though  the  general  conception  were  held  by  each,  to  explain 
the  specific  elements  necessary  in  a  normal  condition  is  a 
task  of  some  considerable  difficulty.  If  we  answer  that  a 
normal  body  is  one  in  which  the  different  parts  are  working 
in  harmony  we  have  a  satisfactory  general  answer.  But  if 
we  attempt  to  give  the  several  elements  a  mathematical  value 
and  then  insist  in  measuring  every  individual  by  that  stand- 
ard we  will  certainly  meet  with  insurmountable  difficulty.  If 
by  careful  estimates  we  determine  that  33  grams  of  urea  is 
the  normal  amount  excreted  in  24  hours,  shall  we  call  that 
individual  abnormal  who  excretes  only  28  grams?  If  we 
determine  that  72  beats  per  minute  shall  be  the  standard  for 
heart  action,  shall  we  decide  that  Napoleon  whose  heart  rate 
was  40  and  that  others  whose  rate  was  below  or  above  the 
average  figure  were  not  normal?  In  relation  to  men  collect- 
ively, then,  no  standard  of  normality  can  be  given.  But  how 
about  the  individual?  Can  we  establish  a  standard  for  each 
individual?  The  difficulties  are  identical.  The  individual 
condition  is  continually  changing  in  quality  and  quantity  of 
functioning.  The  change  is  no  evidence  of  a  departure  from 
the  normal.  It  is  the  normal  that  varies  and  hence  an  absolute 
value  cannot  be  given  to  the  various  elements  constituting  a 
normal. 

If  we  shall  make  symptoms  the  criterion  of  our  judg- 
ment we  shall  certainly  fail  in  numerous  cases.  Many  dis- 


SOME   FUNDAMENTAL   CONSIDERATIONS.  65 

ease  conditions  are  present  for  long  periods  of  time  though 
presenting  absolutely  no  noticeable  symptoms,  subjective  or 
objective.  Further,  certain  changes  in  appearance  ordi- 
narily considered  symptomatic  of  disease  are  not  so  in  reality; 
for  instance  a  rapid  heart  beat  is  usually  apparent  following 
the  climbing  of  a  steep  hill.  The  individual  is  subjectively 
distressed  and  the  objective  symptom  of  rapid  heart  beat  is 
present.  But  the  actual  condition  instead  of  being  abnormal 
is  normal  under  the  circumstances.  Is  pain  an  abnormal  condi- 
tion? Not  necessarily  nor  usually.  Subjectively  it  is  a 
psychic  condition  and  as  such  is  in  one  sense  a  product  of 
cerebral  activity.  In  so  far  as  it  is  a  warning  it  is  a  normal 
condition  though  it  is  usually  if  not  always  evidence  of  some 
abnormal  condition.  This  is  equally  true  of  other  subjective 
symptoms.  We  cannot,  therefore,  rely  upon  symptoms  as  a 
criterion  for  judgment  of  a  normal  condition.  The  best  that 
can  be  done  under  the  circumstances  is  the  determination,  by 
comparisons  ivith  the  average  condition  of  the  average  individual 
with  modifications  of  judgment;  dependent  upon  the  presence 
or  absence  of  symptoms,  as  to  the  degree  of  abnormality,  the 
line  of  demarcation  between  normal  and  abnormal  being  a 
non-determinable  quantity. 

While  it  is  true  that  the  details  constituting  a  normal 
condition  are  not  confined  within  known  and  unyielding  lim- 
its, the  general  forces  back  of  the  ".tendency"  may  be  de- 
termined. In  the  first  place  there  are  two  fundamental  forces 
associated  with  the  life  of  each  organism,  the  first  of  which  is 
heredity.  By  the  term  we  mean  that  peculiarity  derived  from 
the  total  ancestry  that  compels  a  likeness  to  type.  What  is  in- 
herited? (a)  The  life  principle  itself  and  (b)  the  general  form 
and  function.  It  is  to  be  noted  that  inheritance  does  not  refer 
simply  to  the  relation  between  immediate  parent  and  offspring 
but  between  the  whole  line  of  ancestors  and  the  individual. 
An  individual  may  present  the  special  peculiarities  of  his 
grandsire  rather  than  those  of  his  sire,  in  which  case  we  have 
a  special  quality  of  germ  plasm  handed  down  through  the 


66  PRINCIPLES   OF   OSTEOPATHY. 

parents  but  not  becoming  manifest  in  them,  to  reappear  in 
developed  form  in  the  grandson.  Such  a  reversion  to  an- 
cestral characters  is  technically  referred  to  as  atavism. 

The  second  great  force  is  that  of  adaptation  by  which 
we  mean  the  peculiarity  that  permits  an  unlikeness  to  type — a  pe- 
culiarity which  is  dependent  on  the  environment  for  its  man- 
ifestation. What  varies?  The  special  features  and  functions. 
No  two  individuals  are  alike  in  their  structural  or  their  func- 
tional characters;  and  this  individual  variation,  in  so  far  as 
it  is  not  a  likeness  to  some  ancestor,  is  dependent  on  condi- 
tions of  environment,  i.  e.,  dependent  on  stimuli  acting  upon 
the  organism  during  its  separate  existence. 

Both  of  the  two  great  forces  are  necessary ;  the  one  in 
order  that  stability  shall  be  preserved  and  the  identity  of  the 
species  maintained;  the  other  in  order  that  the  individual 
shall  not  be  disintegrated  because  of  an  absolutely  unyielding 
nature.  Each  one  of  the  two  forces  tends  to  counteract  the 
extreme  tendencies  of  the  other  and  hence  the  happy  me- 
dium is  maintained.  Heredity  alone  would  make  an  absolute 
condition  necessary  to  a  normal  one.  No  adaptation  to  the 
continually  arising  new  circumstances  could  be  possible. 
Because  of  the  adaptation  associated  with  living  material 
variation  is  possible.  Hence  the  limits,  the  boundaries  of  the 
field  of  normal  action  are  markedly  widened.  Recognizing  the 
two  forces  we  may  explain  in  a  general  way  individual  peculiar- 
ities such  as  difference  in  heart  beat,  in  bowel  activity,  and  per- 
spiration; and  circumstantial  peculiarities  such  as  increase  in  res- 
piration dependent  on  altitude,  hypertrophy  of  the  heart  in 
valvular  disorders,  thickening  of  tissues  in  cases  of  continual 
wear.  These  considerations  become  of  special  interest  and  fun- 
damental importance  to  the  osteopath  especially  in  their  ap- 
plication to  the  determination  of  lesions.  In  a  later  chapter 
we  shall  indicate  in  detail  the  points  necessary  to  consider  in 
the  diagnosis  of  a  lesion  but  in  this  connection  we  wish  to 
emphasize  one  case.  The  tendency  of  the  beginning  osteo- 
path is  to  assume  that  every  variation  of  structure,  especially 


SOME   FUNDAMENTAL   CONSIDERATIONS.  67 

in  the  position  of  the  spinous  processes,  is  a  lesion.  The 
foregoing  considerations  would  suggest  some  possible  ex- 
ceptions. And  experience  demonstrates  that  there  are  num- 
erous exceptions.  The  spinous  process  may  be  deviated  be- 
cause of  an  over- development  of  muscles  on  one  side — the 
right  in  "right-handed"  individuals,  for  example, — or  from  a 
faulty  condition  of  nutrition  in  foetal  life,  or  from  various 
other  forces,  which  while  causing  an  appreciable  variation 
from  the  average  condition  does  not  cause  or  predispose  to 
disease,  and  hence  could  not  be  rightly  called  a  lesion. 
What  is  true  of  the  position  of  parts  is  true  of  the  several 
other  conditions  that  may  be  present.  In  all  considerations 
of  diagnosis  the  possibility  of  unusual  appearances  being  normal 
must  be  recognized. 

A  normal  individual,  then,  is  one  sufficiently  like  the  species  to 
maintain  its  identity  as  a  member  of  that  species  but  pliable  enough 
to  change  sufficiently  to  meet  the  average  emergencies  of  environment. 
If  the  incident  forces  are  sufficiently  intense  or  prolonged  to 
produce  a  modification  beyond  the  limits  of  adaptive  response 
disease  will  result.  Otherwise,  while  function  and  structure 
may  be  temporarily  modified,  disease  beyond  the  limits  of 
self-cure  will  not  occur. 

This  tendency  to  the  normal  results  from  certain  well 
known  principles  which  may  be  enumerated. 

1.  First  are  those  of  a  physical  nature.     Self -reduc- 
tion of  luxations  depend   to   a  considerable   extent  upon   the 
difference  in  mechanical  tension  on  opposing  parts  of  the  lux- 
ated structure;  in  the  case  of  the  formation  of  a  new  acetabu- 
lum  the  mechanical  pressure  operates  to   produce   the  cavity. 
The  discharge  of  irritating  particles  from  the  bronchi  is   ef- 
fected by  an  apparatus  which  utilizes  air  pressure. 

2.  Or  the  tendency  may  depend  upon  chemical  con- 
ditions.    The  carbon  dioxid  acts  as  a  chemical  stimulus  to  the 
nerve  cells  controlling  respiration.     The  immunity  to   certain 
diseases  through  the  medium  of  an  increased  antitoxic   con- 
dition of  the  blood  is  secured  by  chemical  means.    The  coagula- 


68  PRINCIPLES   OF   OSTEOPAHTY. 

tion  of  the  blood  thereby  preventing  its  own  loss  is  largely  a 
chemical  process. 

3.  Finally,  the  tendency  is  dependent  to  a  considerable 
degree  upon  certain  vital  principles.  The  protection  from  loss 
in  the  more  essential  organs  in  the  case  of  the  deprivation  of 
food  above  referred  to;  the  formation  of  a  stomach  and  arrange- 
ments for  gastric  digestion  in  other  parts  of  the  alimentary 
canal  when  the  stomach  itself  has  been  obliterated  or  render- 
ed ineffective;  and  the  chemotactic  action  exhibited  by  the 
white  corpuscle  in  the  presence  of  the  pathogenic  bacteria  are 
illustrations  of  this  principle. 

It  is  not  to  be  presumed  however  that  these  various  sep- 
arate principles  act  separately  in  bringing  about  the  adjust- 
ment. It  is  likely  that  in  no  case  is  this  true  but  that  the 
three  are  associated  and  co-ordinated  by  the  vital  force 
of  the  organism;  and  thus  continually  guarding  and  restor^ 
ing,  the  organism  is  enabled  to  pass  its  alloted  existence  in  a 
world  rife  with  changes  of  environment  which  may  at  any 
time  be  sufficient  to  inaugurate  disease.  But  by  virtue  of  the 
tendency  exercised  both  in  ordinary  and  extraordinary  cir- 
cumstances it  may  usually  triumph,  and  hence  it  is  in  a  very 
real  sense  that  the  statement  is  true  that  "disease  is  the 
stimulus  to  its  own  cure." 


MJ<*M 

our 


fi^  ko-cAvtw  . 


FIG.    5. — Illustrating  the  action  of  forces  of  Heredity  and  Adaptation. 


THE   ETIOLOGY   OF  DISEASE.  69 


CHAPTER  IV, 


THE  ETIOLOGY  OF  DISEASE. 

In  a  previous  chapter  it  was  suggested  that  health  repre- 
sents a  condition  of  body  harmony  and  that  disease  is  body 
discord.  For  purposes  of  convenience  we  may  accept  as 
our  definition  of  disease  perverted  function.  While  this 
is  not  entirely  satisfactory  in  that  most  diseases  are  associated 
with  structural  changes  also,  yet  the  appearances  so  strongly 
emphasize  the  prime  importance  of  functional  perverson  that 
we  shall  make  use  of  the  phrase. 

Granting  that  there  are  limits  to  the  self -regulating  power 
of  the  organism  and  that  disease  does  exist,  it  becomes  neces- 
sary to  inquire  into  .the  cause  of  disease ;  and  first  will  be 
mentioned  the  most  important  of  two  general  causes. 

ABNORMAL  STRUCTURAL  CONDITIONS. 

Whatever  in  addition  he  may  be  man  is  certainly  a  ma- 
chine. It  is  further  obvious  that  the  function  of  a  machine 
i.  e.,  its  action,  is  absolutely  dependent  on  its  structural  in- 
tegrity and  that  just  as  soon  as  any  part  of  the  machine  be- 
comes disturbed  in  relation  to  other  parts  disorder  of  action 
will  result.  Is  this  true  of  the  man-machine?  It  would  seem 
a  simple  proposition  easily  answered.  Yet  objection  is  of- 
fered. Without  at  this  time  entering  into  a  discussion  of  the 
relative  placing  of  structure  and  function,  a  few  facts  may  be 
indicated  tending  to  prove  indisputably  the  contention  that 
abnormal  structural  conditions  are  a  fundamental  cause  of  per- 
verted function. 

Medical  and  surgical  history  teems  with  records  of  cases 
where  at  least  gross  anatomical  disturbances  initiate 
definite  and  far-reaching  physiological  disorder.  A  few  of 
such  cases  will  be  specified.  Adislocated  hip  will  cause  sciatica. 
How  does  it  do  so?  By  direct  pressure,  not  necessarily  on 


70  PRINCIPLES   OF   OSTEOPATHY. 

the  nerve  perhaps,  but  upon  structures  closely  enough  as- 
sociated with  it — its  blood  supply,  for  example — to  result  in 
its  disorder.  A  dislocated  cervical  or  even  lumbar  vertebra  will 
cause  paralysis  by  pressure  upon  the  spinal  cord  or  upon  its 
sources  of  supply.  An  occluded  artery  will  cause  dry 
gangrene  and  .an  occluded  vein  will  cause  moist  gangrene. 
Note  Nancrede's  statement:  "Indeed  except  when  the  trau- 
matism  physically  disintegrates  tissues  as  a  stone  is  reduced 
to  powder,  heat  or  strong  acids  physically  destroy  structure, 
or  cold  suspends  cellular  nutrition  so  long  that  when  this  nu- 
trition becomes  a  physical  impossibility  vital  metabolism  can 
not  be  resumed,  gangrene  always  results  from  total  deprivation 
of  pabulum."  (Italics  mine).  He  also  indicates  what  most 
surgeons  assert  that  the  moist  form  depends  in  part  upon  in- 
terference with  the  drainage.  Aflat  chest  vitiates  lung  tissue 
and  renders  it  susceptible  to  invasion  by  bacteria.  Pregnancy 
by  pressure  on  renal  vessels  produces  albuminuria.  Sclerosis, 
i.  e.,  overgrowth  and  hardening  of  connective  tissue  structures 
causes  interference  with  nerve  impulses  in  tabes  dorsalis, 
spastic  paraplegia,  and  similar  conditions.  A  sprained  ankle 
causes  congestion  and  infiltration,  thereby  producing  various 
sensory  and  motor  disturbances  directly  and  reflexly.  And 
finally,  as  stated  by  Hill  in  Schafer's  Physiology,  "the 
movements  of  the  muscles  of  the  neck  by  pressing  on  the  jugular 
vein  are  sufficient  to  affect  the  cerebral  circulation." 

In  all  of  the  cases  mentioned  above  we  have  illustrations 
of  the  fact  that  function  depends  on  structure.  That  such 
cases  exist  is  recognized  by  all  authorities  and  is  disputed  by 
none.  In  all  of  these  cases  the  anatomical  perversion  is  a  gross 
one  and  the  functional  change  is  also  gross.  Why  should  we 
limit  the  application  of  the  principle  to  the  gross  cases? 
Let  us  further  analyze  some  of  the  above  instances.  All  are 
agreed  that  the  dislocation  of  a  hip  can  produce  an  inflamma- 
tion of  the  sciatic  nerve.  Is  it  a  greater  tax  on  the  intellect 
to  conceive  of  a  less  severe  functional  disorder  dependent  up- 
on a  less  severe  structural  perversion?  If  an  intense  stimu- 


THE  ETIOLOGY  OF  DISEASE.  71 

lus  will   produce   the  neuritis  why  will  not  a  less  intense  but 
long  continued  stimulus  produce,  if  not  a  neuritis,  at  least  an 
appreciable  disorder  of  some  other  kind,  for  instance  a  deaden- 
ing effect,  a  numbness,  or  a  change  in   vaso-motor  impulses 
that  are  carried  by  the  sciatic  nerve?    And  what  is  the  source 
of  this   long  continued  but  less  intense  stimulus?    Among 
other  things,  a  slightly  subluxated  innominatum  or  other  of 
the  bony  structures  which  are  closely  associated  through  their 
ligamentous  and  muscular  connection,  with  the  sciatic   nerve 
in  its  course  or  at  its  origin.     Is  it  possible  that  the  innomina-\ 
turn  can  be  subluxated?     Undoubtedly.     Any  bone  having  a  , 
definite  articulation  can  be  subluxated.     A  slight  twist  of  the 
innominatum  at  its  articulation  with  the  sacrum  constitutes  a  j 
real  subluxation  and  of  sufficient  degree  to  produce  tension ) 
upon  its  associated  structures.     Note  the  case  of  the  paralysis 
dependent  on  dislocation  of  a  cervical  vertebra.     Is  it  an  in- 
sult to  intelligence  to  assent  to  the  proposition  that  if  a  gross 
dislocation  can  produce  a  paralysis  a  less  perversion,  for  in- 
stance a  severe  torsion  or  strain,  may  so  impinge  not  upon 
the  cord  directly   but  upon   the  innumerable   channels  that 
connect  the  contents  of  the  neural  canal  with  the  structures 
anterior  to  the  spinal  column,  as  to  very  materially   interfere 
with  the   exchange  between  those  regions?      We  think  not. 
If  it  be  possible  that  gangrene  of  a  tissue  is  dependent  on   the 
total  obstruction  to  the  arterial  supply  to  that  tissue,  why  is  it 
not  reasonable  that  a  partial   interference  with  the  flow  of 
blood    through   an    artery   may  result  in  a  less  completely 
starved  condition?    That  partial  interference   may   easily  be 
produced  by  direct  pressure  of  structures  upon  it  or  by  inter- 
ference with  the  nerve  mechanism  which  governs  its  diameter. 
If  the  lungs  are  weakened  by  a  depressed  condition  of  the  tho- 
racic walls,  why  is  it  not  true  that  the  heart  may  suffer  from 
a  like  crowding?    If  it  be  possible  that  contraction  of  cervical 
muscles  produces  a  change  in  cerebral  circulation  why  may 
not  a  contractured-ie. ,  chronically  contracted- -muscle  produce 
a  chronic  disturbance  of  that  circulation  and  hence  a  conges- 


72  PRINCIPLES   OF   OSTEOPATHY. 

tive  headache.  If  a  pregnant  uterus  by  virture  of  its  size  and 
weight  may  produce  renal  disorder  by  pressure,  why  may  not 
a  tumor,  a  contractured  muscle  or  a  subluxated  bone,  acting 
upon  a  vital  structure  directly  or  indirectly  connected  to  the 
kidney,  produce  disorder  of  that  organ  in  a  similar  manner? 

If  a  sclerosis  interfere  with  nerve  impulses  in  the  spinal 
cord,  why  may  not  a  thickening  of  tissues  connecting  vertebra 
with  vertebra  produce  similar  disturbance  in  the  nerve  fibers 
or  blood  vessels  which  pass  so  numerously  into  and  out 
from  the  spinal  canal,  among  and  between  and  through  those 
connecting  bands?  If  a  sprained  ankle  is  a  common  occurence 
and  if  congestion  and  infiltration  are  resulting  conditions 
which  cause  direct  and  reflex  disturbances,  why  is  it  such  a 
draft  upon  credulity  to  believe  that  a  similar  common  condi- 
tion of  sprain  with  similar  congestions  and  infiltrations  and 
similar  direct  and  reflex  disorders  may  occur  in  the  scores  of 
articulations  which  are  presented  by  the  spinal  column? 

But  it  is  not  necessary  to  rest  the  case  entirely  on  assump- 
tion. Evidence  has  been  accumulated  and  is  still  accumu- 
lating which  is  most  confirmatory  in  character.  Case  after 
case  has  been  found  by  osteopaths  who  are  careful  in  obser- 
vation and  logical  in  judgment,  showing  that  these  various 
structural  perversions  are  present  and  are  associated  with 
functional  disorders,  the  removal  of  the  structural  condition 
uniformly  resulting  in  a  disappearance  of  the  disorder.  It  is 
at  the  present  time  not  so  much  a  question  as  to  the  fact  that  a 
structural  disorder  produces  the  disease  as  to  the  details  of 
the  manner  in  which  the  latter  is  brought  about. 

DISEASE  MAINTAINED  BY  STRUCTURE. 

It  is  not  of  such  moment  as  to  what  was  the  original 
stimulus  to  a  disordered  function.  We  have  no  quarrel 
with  those  who  insist  that  the  functional  disorder  may  result 
from  a  multitude  of  forces  which  'act  continually  upon  the 
organism.  It  is  readily  admitted  that  constant  disregard  for 
well  known  laws  of  health  must  of  necessity  produce  disorder, 


THE  ETIOLOGY  OF  DISEASE.  73 

and  in  another  section  special  attention  is  called  to  the  fact. 
A  thousand  conditions  of  environment  and  of  individual  may 
initiate  or  predispose  to  disorder  of  function.  This  fact  must 
be  recognized  in  order  that  the  individual  shall  understand 
that  he  must  reap  what  he  sows.  It  must  be  a  part  of  the  work 
of  the  physician  as  it  is  only  less  emphatically  the  duty  of 
every  man  to  assist  in  a  proper  understanding  of  the  ordinary 
laws  of  responsibility  for  one's  own  health,  body,  mental  and 
spiritual.  Temperance  in  all  things  is  absolutely  a  pre- 
requisite for  continued  well  being.  Any  intemperance  will 
result  in  at  least  a  temporary  impairment  of  function.  With 
most  normal  individuals  a  few  experiences  will  teach  wisdom. 
Hence  most  individuals  pass  through  life  with  a  fair  degree 
of  health  so  far  as  disorders  dependent  on  wilful  abuse  is  con- ; 
Deemed.  When,  however,  a  disorder  becomes  manifest  and 
persists  in  spite  of  removal  of  the  intemperance  or  abnormal 
condition  or  environment  we  are  justified  in  assuming  that 
some  other  factor  is  maintaining  the  disease,  for  function  is 
infinitely  self-regulative.  We  maintain  that  the  other  factor  is 
perversion  of  stricture  and  that  structure  is  a  part  which  is  less 
immediately  and  less  completely  subject  to  vital  control — the 
more  inert  tissues  such  as  bone,  ligament,  cartilage  and  other 
connecting  structures.  Hence  where  a  disorder  is  maintain- 
ed, we  assert  from  reason  and  observation, that  the  structural 
condition  is  the  factor  that  prevents  a  return  to  normal  functioning 
The  question,  therefore,  is  not  as  to  the  original  force  that 
caused  the  disorder,  but  why  does  not  the  sick  man  get  well.  It  is 
just  as  much  a  normal  power  of  the  organism  to  produce  a 
return  to  normal  functioning  as  it  is  to  maintain  functional 
equilibrium  manifest  in  the  ordinary  healthful  life.  It  is  in 
fact  impossible  to  actually  differentiate  between  the  two.  An 
excess  of  carbon  dioxid  is  a  normal  stimulus  to  the  removal  of 
that  excess.  This  is  true  in  other  cases.  The  organism  restores 
continually  its  proper  function  largely  through  the  medium 
of  stimuli  furnished  by  its  own  katabolic  products.  The  pres- 
ence of  other  substances  not  nutritive  in  character,  e.  g.,  bac- 


74  PRINCIPLES   OF   OSTEOPATHY. 

terial  excreta,  produces  a  similar  result.  Whether  through 
ages  of  adaptation  and  from  hereditary  transmission  or  from 
inherent  endowment  coequal  with  life  itself,  the  fact  that  this 
self -protective  power  exists  may  be  affirmed  with  little  proba- 
bility of  error ;  and  that  function  is  absolutely  self-regula- 
tive while  structure  is  only  less  responsive  to  the  same  forces 
is  equally  certain.  Hence  in  the  ordinary  disorder  that  seems 
beyond  the  limits  of  self-restoration  we  must  logically  look  to 
the  structural  condition  for  the  factor  maintaining  the  dis- 
order. And  experience  has  shown  that  little  in  addition  is 
needed,  for  with  the  average  individual  the  average  environ- 
ment constitutes  a  normal  condition.  With  such  an  environ- 
ment to  which  the  individual  has  long  been  accustomed  the 
organism  is  master  of  the  situation  and  needs  only  freedom  to 
exercise  its  restorative  powers. 

The  truth  of  these  considerations  is  evident  in  case  of 
chronic  disorder.  But  they  are  no  less  true  if  less  evident  in 
acute  conditions.  A  certain  prominent  instructor  in  a 
recognized  medical  college  told  his  students  on  the  occasion 
of  tfieir  graduation  that  95  per  cent  of  their  acute  cases  would 
get  well  whether  they  were  treated  or  not.  We  are  not  sure 
that  the  percentage  is  too  high.  This  does  not  argue  for  a 
policy  of  non-interference.  For  osteopathic  experience  shows 
unquestionably  that  the  reparative  forces  may  be  given  great- 
er freedom  for  action  by  appropriate  treatment.  In  general 
the  length  of  time  required  by  the  unaided  organism  to  restore 
normal  conditions  may  be  lessened  one-half.  What  is  the 
philosophy  of  the  treatment  under  such  circumstances?  Under 
the  influence  of  an  excessive  stimulus,  i.  e.,  a  marked  disease 
condition,  the  organism  exerts  its  full  powers  of  response  but 
very  materially  at  the  expense  of  certain  secondary  abnormal 
functioning.  That  is,  the  vital  forces  are  all  concerned  with 
the  state  of  emergency,  which  diverts  attention  from  certain 
functional  and  structural  conditions  that  under  the  circum- 
stances are  secondary  in  importance.  These  together  with 
the  added  disorganizing  factor  of  an  excess  of  stimuli  due  to 


THE   ETIOLOGY   OF   DISEASE.  75 

the  disease  become  more  or  less  deranged.  As  a  result  we 
see  the  varying  symptoms  which  represent  in  large  part 
evidences  of  the  secondary  disorganization.  One  of  the  most 
common  of  the  latter  is  change  in  structural  relations,  e.  g., 
contractured  muscles.  But  contractured  muscles,  directly  and 
through  their  attachment  to  bone  or  other  tissue,  further  dis- 
turb structural  relations  and  hence  an  additional  causal  factor 
is  presented.  This  structural  perversion  which  has  been  pro- 
duced secondarily  is  an  added  cause  not  so  much  of  the  dis- 
ease but  of  the  inability  of  the  organism  to  immediately  re- 
cover. Hence  by  keeping  the  structural  conditions  reduced 
the  total  time  for  recovery  will  be  appreciably  shortened.  If 
this  assistance  is  not  given  the  organism  will  recover  in  most 
cases  unaided.  But  in  others  the  disease  will  become  chronic 
not  because  the  f auction  delights  in  irregularity  nor  because  the 
environment  or  habit  of  the  patient  is  necessarily  an  insur- 
mountable hindrance,  but  because  the  inert  structure  which 
was  disturbed  has  become  set  in  its  new  relations  and  the 
normal  tension  of  surrounding  tissues  is  insufficient  to  re- 
adjust. 

It  is  not  necessary  to  assume  that  the  perverted  structure 
arose  as  a  secondary  result.  It  is  enough  to  note  that  in 
countless  cases  there  exists  a  deranged  structural  condition 
which,  not  of  itself  capable  of  producing  marked  disorder,. 
yet  permits  of  a  lessened  resistance  to  the  extraordinary 
stimuli  and  when  the  disease  results  from  the  latter,  prevents 
a  complete  response  to  the  new  conditions  by  interfering  with 
normal  nerve  or  blood  action.  In  such  cases  the  structural 
difficulty  is  part  of  the  original  cause  of  the  disease  in  that 
it  represents  a  predisposition.  It  becomes  the  principal  if 
not  entire  factor  which  prevents  a  ready  return  to  normal. 

THE  LESION. 

By  osteopathic  usage  the  word  lesion  has  come  to  have  a 
special  significance.  The  surgical  conception  of  lesion,  i.  e., 
any  hurt  or  injury  to  a  part,  and  the  pathological  concept,  i.  e., 


76  PRINCIPLES   OF   OSTEOPATHY. 

any  local  or  circumscribed  area  of  tissue  undergoing  abnor- 
mal functional  changes,  must  be  carefully  distinguished  from 
the  osteopathic  concept  which  is  any  structural  perversion  which  by 
pressure  produces  or  maintains  functional  disorder.  Note  first 
that  the  definition  includes  all  tissues.  While  it  is  true 
that  the  bony  lesion  occupies  first  place  by  virtue  of  history 
and  importance  muscular  and  ligamentous  are  rivals  of  the  for- 
mer for  pre-eminence.  A  viscus  may  act  as  a  lesion,  and 
sunong  the  most  serious  of  diseases  are  those  directly  depend- 
ent upon  pressure  from  prolapsed  viscera.  In  the  second 
place  note  that  the  structure  must  be  perverted,  that  is  not 
normal — has  departed  from  the  usual  or  average  condition. 
Third,  note  that  the  condition  of  function  is  included  in  the  con- 
ception of  lesion.  This  is  of  fundamental  importance.  From 
what  has  been  said  in  a  previous  section  it  can  be  understood 
that  a  structure  may  be  perverted  in  the  sense  of  being  unusu- 
al and  still  not  be  a  cause  of  change  of  function.  This  varia- 
tion is  still  within  the  limits  of  normal  adaptation.  A  spine 
may  have  its  curves  markedly  exaggerated  or  completely  ob- 
literated and  the  functional  conditions  still  remain  normal. 
To  make  of  it  a  lesion  in  the  osteopathic  sense  there  must  be 
included  the  idea  of  functional  disorder  as  a  consequence  of 
the  structural  perversion.  Finally,  note  that  the  disorder  is 
produced  by  pressure.  This  latter  idea  is  the  keynote  in 
disease  causes.  We  believe  this  conception  of  the  term  lesion 
is  the  proper  one  from  the  standpoint  of  usage,  convenience 
and  simplicity.  /. 

The  perverted  structural  condition  may  be  a  disturbed 
positional  relation  of  parts.  These  may  be  further  class- 
ified into  (a)  dislocations,  which  usually  refer  to  bony  tissue 
and  represent  a  condition  in  which  there  is  a  complete  sepa- 
ration of  the  articular  surfaces.  An  example  of  this  class 
would  be  a  hip  dislocation,  (b)  Sub-luxation,  also  usually  re- 
ferring to  bony  structures  but  in  which  there  is  an  incom- 
'plete  separation  of  the  articular  surfaces.  A  rib  is  more 
commonly  subluxated  than  dislocated,  (c)  Displacement  is 


THE  ETIOLOGY   OF  DISEASE.  77 

more  commonly  applied  to  yielding  structures  and  especially 
viscera  in  which  there  is  no  well  marked  or  special  articula- 
ting surfaces.  We  can  more  appropriately  speak  of  a  dis- 
placed uterus  than  of  a  sub-luxated  or  dislocated  one.  (d) 
The  lesion  may  be  in  the  nature  of  a  contracture,  more  especi- 
ally of  muscle  tissue.  While  it  is  true  that  all  living  tissue 
is  more  or  less  susceptible  to  change  in  shape  through  the 
phenomenon  of  contraction,  muscle  tissue  because  of  its 
specially  developed  power  in  this  particular  must  occupy  first 
place.  While  the  contracture  is  a  position  change  it  is  also 
a  size  change  and  might  appropriately  be  considered  in  the 
next  division.  For  there  is  undoubtedly  in  the  majority  of 
muscular  contractures  an  increase  in  the  total  bulk  of  the 
muscle  though  not  necessarily  in  the  amount  of  muscular 
fiber. 

In  the  second  place  the  disorder  may  be  a  disturbed 
size  relation  of  parts.  These  may  be  also  further  classi- 
fied into  (a)  lesions  from  overgrowth.  In  the  case  of  a  hyper- 
trophied  heart  or  a  thoracic  aneurism  direct  pressure  is 
exerted  upon  the  lungs  and  other  thoracic  structures  with 
resulting  disorder  of  their  function,  (b)  Arrested  growth  and 
(c)  atrophy  are  less  common  conditions  but  are  occasionally 
noted.  In  the  case  of  an  atrophied  liver  the  resulting  dis- 
turbance of  associated  abdominal  viscera  may  be  directly  de- 
pendent upon  this  size  disturbance,  (d)  Perverted  groivth  as 
in  the  case  of  exostoses  and  tumors  which  are  special  forms 
of  overgrowth  conditions.  We  have  referred  to  the  fact 
fundamental  in  importance  that  the  lesion  produces  diseases 
by  a  pressure  effect.  In  what  way  is  that  pressure  applied? 
The  question  demands  a  rather  extended  discussion  but  will 
be  briefly  outlined  in  this  connection. 

MEDIA  THROUGH  WHICH  LESIONS  PRODUCE  DISEASE. 

1.— Direct  pressure  may  cause  the  organs  to  be  involved 
in  disease.  A  rib  or  ribs  may  be  depressed  thereby  pressing 
directly  upon  the  lungs,  or  what  is  equivalent  to  that  pres- 


78  PRINCIPLES   OF   OSTEOPATHY.  .4 

sure,  prevents  their  normal  expansion  resulting  in  an  imme- 
diate disorder  or  a  lessened  resistance  to  specific  infection. 
A  floating  kidney  may  press  directly  upon  the  bowels  thereby 
inducing  constipation  or  other  trouble.  The  pyriform&ts  mus- 
cle or  others  closely  associated  may  in  contracture  impinge 
directly  upon  the  sciatic  nerve  causing  a  neuritis. 

2 — Pressure  .upon  the  artery  which  supplies  it  causes  an 
anaemic  condition  of  the  organ  and  a  possible  secondary  hy- 
peraemia  of  some  closely  associated  part.  By  virtue  of  a  tor- 
sion of  the  cervical  vertebra  with  a  consequent  tightening 
and  thickening  at  intervertebral  ligaments  the  blood  flow 
through  the  intervertebral  artery  is  hindered  and  the  spinal 
cord  suffers.  An  approximated  condition  of  the  upper  ribs 
impairs  the  arterial  supply  to  the  mammary  gland  and  the  se- 
cretion of  milk  is  hindered.  An  abdominal  tumor  or  a  preg- 
nant condition  impinges  on  the  renal  arteries  and  kidney 
trouble  is  experienced. 

3. — Pressure  upon  the  vein  which  drains  it  causes  a 
hypersemia  of  the  organ  with  a  possible  secondary  anosmia 
of  closely  associated  structures.  A  depressed  sternum  and 
anterior  ends  of  clavicle  and  first  rib  through  pressure  upon 
the  inferior  thyroid  veins  causes  goitre.  A  tightened  muscular 
and  ligamentous  condition  about  the  saphenous  opening 
causes  varicose  veins.  Muscular  contractures  in  the  cervical 
regions  interferes  with  the  drainage  from  the  cephalic  struc- 
tures and  a  congestive  headache  results.  In  cirrhosis  of  the 
liver  an  obstruction  to  the  portal  system  occurs  with  a  resulting 
abdominal  dropsy  and  a  secondary  anaemia  of  other  parts 
of  the  body. 

4. — The  organ  may  be  disordered  by  pressure  upon  the 
lymph  channels  with  which  it  is  associated  thereby  pro- 
ducing innumerable  disordered  conditions  through  the  inter- 
ference with  the  nutritive  and  sewerage  functions  of  the 
lymph,  and  by  a  secondary  process  materially  affecting  the 
general  vascular  system. 

5. — Pressure  upon   a  nerve   directly  or  reflexly  con- 


THE    ETIOLOGY   OF   DISEASE. 


79 


nected  with  it  causes  organic  disorder.  The  heart  may  be 
interfered  with  by  tightened  ligaments  causing  pressure  upon 
the  cardiac  accelerators  which  issue  from  the  spinal  cord  from 
the  first  to  the  fourth  thoracic  segments,  or  it  may  be  involv- 
ed in  disorder  partly  dependent  upon  an  excess  of  impulses 
transmitted  to  it  by  way  of  the  hypogastric  and  solar  plexuses 
from  a  disturbed  uterine  condition,  in  which  case  we  have 
reflex  effect.  Or  the  accelerators  may  carry  too  many  or 
rapid  impulses  to  the  heart  dependent  on  contractured  spinal 
muscles  in  the  upper  thoracic  area,  this  being  also  a  case  of 
disturbance  dependent  upon  reflex  action.  Note  the  physio- 
logical law  that  the  total  activity  of  a  segment  of  the  spinal  cord  va- 
ries directly  with  the  total  number  of  impulses  passing  to  it.  Hence 
a  contracture  of  a  spinal  muscle,  by  increasing  th6  incoming 
impulses  through  impingement  on  sensory  nerves,  will  cause 
hyper-activity  of  the  cord  segment  and  a  resulting  increase 
of  accelerator  impulses  out  over  the  cardiac  nerves.  This 
law  is  uniform  and  will  explain  most  visceral  disturbances 
dependent  on  muscle  contracture.  Note  the  extreme  number 

and  variety  of  effects  possible  from 
nerve  disturbance.  A  sensory  im- 
pingement will  produce  pain,  direct 
or  transferred.  Every  sensory  nerve 
is  a  possible  pathway  for  impulses 
setting  in  motion  a  vaso  motor  change; 
hence  anaemic  or  hypersemic  con- 
ditions may  result.  It  will  also  in- 
itiate excessive  activity  of  the  sweat 
glands  and  hence  perspiration  be- 
comes abnormal.  It  may  carry  the 
impulse  which  inaugurates  the 
change  in  any  efferent  channel  and 
FIG.  6.— illustrating  the  numer-  ^ence  motion  may  be  increased  or 

-    of    disturbance   of 


ous    sources 


viscus. 


decreased,  secretion  accelerated  or 
depressed  inhibition  modified,  trophicity  lessened.  All  of 
these  effects,  are  dependent  on  interference  with  afferent  or 


80  PRINCIPLES   OF  OSTEOPATHY. 

sensory  nerves.  On  the  other  hand  the  efferent  channels 
themselves  are  equally  subject  to  interruption  while  any 
change  in  the  nutritive  condition  of  a  segment  of  the  spinal 
cord  or  a  center  in  the  brain  will  affect  to  a  greater  or  less 
degree  all  nerve  pathways  in  direct  or  reflex  connection 
with  them.  The  medium  of  nerve  interference  is  ivithout  doubt  the 
most  important  with  which  ice  deal. 

Through  these  several  media  we  may  explain  with  great- 
er or  less  satisfaction  the  varied  results  that  have  been  ob- 
served to  follow  the  presence  of  a  lesion.  The  difficulty  lies 
in  determining  in  each  individual  case  which  of  the  several 
explanations  is  the  true  one — a  difficulty  at  once  apparent 
and  in  many  cases  insurmountable.  It  must  further  be  noted 
that  a  lesion  sufficient  to  produce  impingement  on  one  of  the 
channels  will  be  sufficient  to  affect  another,  so  that  in  most 
cases  we  will  have  more  than  one  of  the  channels  interrupted  and 
hence  the  greater  possibility  of  extreme  effects. 

MISCELLANEOUS  NOTES. 

1.  The  extent  of  the  lesion  bears  no  constant  rteation  to  the  in- 
tensity or  extent  of  the  effect.  Note  the  case  of  the  hunch-back 
whose  lesion  condition  is  quite  apparent  and  great  in  extent. 
Yet  in  many  cases  his  health  is  not  markedly  impaired.  On 
the  other  hand  a  slight  strain  at  the  articulation  between  the 
eleventh  and  twelfth  vertebra  has  resulted  in  immediate 
Bright' s  Disease  of  a  very  serious  nature.  The  strain  was  bare- 
ly noticeable  on  palpation  or  inspection  yet  the  effect  was  far- 
reaching.  Several  facts  suggest  an  explanation  of  the  con- 
dition. The  effect  will  vary  directly  with  the  vitality  of  the 
tissue  interfered  with.  If  a  lesion  brings  pressure  upon 
simple  connective  tissue  little  result  may  be  looked  for.  The 
connective  tissue  is  comparatively  inert.  If  the  pressure  be 
upon  nerve  tissue  the  result  is  far-reaching.  Nerve  tissue  is 
most  vital.  It  is  developed  with  the  special  end  in  view  of 
furnishing  a  material  quick  to  respond  to  stimuli  and  capable 
of  conducting  the  impulse  to  other  parts  of  the  body.  Hence 


THE  ETIOLOGY  OF  DISEASE.  81 

a  lesser  intensity  of  stimulus  from  pressure  will  be  necessary 
to  cause  response  than  in  connective  tissue  and  a  much  more 
rapid  transmission  of  the  impulse  will  also  result.  A  muscle 
impinged  upon,  less  vital  than  nerve  in  respect  to  readiness 
of  response  and  speed  of  propagation,  will  be  associated  with 
less  immediate  effect.  An  artery  involved  is  more  likely  to 
result  in  disorder  than  is  some  other  structures  because  of  a 
wider  influence  and  a  more  ready  response  to  pressure. 

Again  the  adjustment  possibilities  of  the  structure 
involved  in  lesion  is  an  important  factor  in  modifying  the 
response;  and  this  is  in  turn  largely  dependent  on  the  abrupt- 
ness and  strength  of  the  stimulus,  i.  e.,  the  pressure  from  the 
lesion.  A  lesion  produced  gradually,  as  is  true  in  most  cases 
of  curvature  of  the  spine,  will  not  constitute  a  change  suffi- 
cient to  be  effective  as  a  stimulus.  For,  note  that  it  is  an  ab- 
rupt change  of  pressures  that  constitutes  a  mechanical  stimulus.  In 
the  case,  then,  of  the  posterior  curvature,  the  extreme 
kyphosis,  the  pressure  has  been  so  gradually  applied  that  the 
structures  in  contact  were  not  stimulated  but  were  able  to 
adapt  themselves  to  the  gradually  changing  conditions.  It  is 
a  rule  recognized  by  physiology  that  a  change  sufficient  to 
produce  a  response  in  a  tissue  if  continuously  applied  will 
later  fail  to  produce  such  response.  The  tissue  hag  adapted 
itself  to  the  stimulus  and  is  not  further  affected  thereby.  In 
the  case  of  the  sudden  wrench  of  an  articulation  causing 
nephritis  the  change  in  pressures  was  so  intense  and  so  abrupt 
as  to  constitute  a  very  efficient  stimulus  so  that  the  extreme 
result  was  brought  about.  It  must  be  noted  however  that 
ultimately  further  adjustment  will  be  impossible  and  the  tis- 
sue must  respond.  Note  that  finally  the  hunch-back  succumbs 
to  conditions  much  less  severe  than  would  otherwise  be  the 
case.  The  summation  of  stimuli  may  help  in  the  explanation  of 
such.  A  stimulus  ineffective  at  first,  by  repeated  operation 
may  cause  such  an  accumulation  of  effect  as  to  result  in  a 
discharge.  The  spine  though  gradually  impinging  upon  a 
nerve  or  other  tissue  will  finally  produce  a  summation  of 
effects  and  disorder  will  result. 


82  PRINCIPLES   OF   OSTEOPATHY. 

2.  Another  important  fact  that  must  be  noted  is  that  the 
region  of  apparent  disturbance  is  not  necessarily  or  usually  the  seat  of 
the  lesion.  While  this  statement  applies  with  more  force  to  the 
subjective  disturbance  of  pain  yet  it  is  noted  in  others  not 
subjective.  With  respect  to  pain,  sufficient  to  refer  to  a  later 
chapter  in  which  is  discussed  the  condition  of  transferred 
pain.  At  present  note  that  the  pain  caused  by  an  irritation 
may  be  felt  in  any  part  of  the  distribution  or  course  of  the 
nerve  irritated.  In  pressure  at  the  elbow  upon  the  ulna  pain 
is  not  only  felt  at  the  point  of  pressure  but  also  and  in  many 
cases  most  markedly  in  the  fingers,  i.  e.,  where  the  nerves 
are  specially  developed  for  receiving  stimuli.  A  lesion  in  the 
spine  by  pressure  on  fibres  forming  the  intercostals  may  pro- 
duce pain  felt  over  the  anterior  surface  of  chest  or  abdomen. 
Hilton's  rule  that  pain  felt  superficially  and  not  accompanied 
by  a  local  rise  in  temperature  indicates  a  spinal  origin  of  the 
pain,  is  interesting  and  helpful  especially  to  osteopaths. 
Especially  is  this  likely  to  be  the  origin  if  the  pain  be  symmetri- 
cal, i.  e.,  on  both  sides  of  the  median  line  at  corresponding 
points.  An  associated  local  rise  in  temperature  together  with 
other  evidences  of  local  inflammation  indicates  the  latter  as 
the  probable  immediate  irritant. 

But  the  application  can  be  made  to  other  than  pain 
conditions.  Note  that  a  pelvic  lesion  primarily  affecting  the 
uterus  may  cause  symptoms  only  with  the  heart,  palpitation  of 
that  organ  being  a  quite  common  result.  In  this  case  the 
patient  and  physician  would  naturally  assume  that  the  heart 
was  primarily  at  fault.  But  experience  suggests  that  it  is 
otherwise,  the  heart  being  affected  through  the  complicated 
mechanism  of  reflex  activity.  The  impulse  from  a  disturbed 
uterus  may  be  transmitted,  for  aught  we  know,  through  a 
choice  of  numerous  pathways  involving  the  reflex — the  numer- 
ous centers  and  their  connecting  fibers  associated  with  the 
pelvic,  hypogastric,  solar  and  cardiac  plexuses,  the  sympa- 
thetic ganglia  and  the  segment  of  the  spinal  cord  being  in- 
volved. But  why  should  the  heart  be  thus  involved  and  not 


THE  ETIOLOGY   OF  DISEASE.  83 

.some  other  organ?  In  answer  it  may  be  said  that  in  other 
cases  and  at  times  in  the  same  case  it  is  another  organ.  Byron 
Robinson's  suggestion  that  it  is  dependent  on  a  condition 
analogous  to  an  electric  arrangement  is  suggestive  but  un- 
satisfactory in  that  there  are  too  many  exceptions.  His  sug- 
gestion is  that  that  organ  will  be  involved  reflexly  which  is 
connected  to  the  primary  organ  by  the  greatest  number  of 
nerve  strands.  Unfortunately  he  does  not  show  that  such  is 
the  case.  Personally  the  author  prefers  another  explanation  in 
which  there  are  noticed  few  exceptions  and  those  perhaps 
only  apparent.  Under  the  circumstances  of  a  perfectly  nor- 
mal condition  of  every  other  organ  of  the  body,  little  disturb- 
ance if  any  will  result  when  the  one  is  disturbed.  The  excess 
of  energy  will  be  more  or  less  equally  distributed  over  the  en- 
tire nervous  system,  perhaps  indeed  more  to  those  offering 
the  least  resistance,  i.  e.,  to  those  having  a  greater  number  of 
nerve  strands.  But  in  most  cases  some  one  or  more  organs 
will  be-  found  in  an  irritable  state  quite  out  of  the  ordinary. 
In  such  a  case  a  nerve  impulse  coming  from  the  organ  pri- 
marily involved  will  be  effective  in  a  much  less  intense  form 
than  would  be  required  in  case  the  organ  were  normal.  Hence 
the  statement  may  be  made  after  this  manner:  that  organ  will 
be  involved  reflexly  which  is  in  the  more  irritable  condition.  The 
excess  of  irritability  in  one  organ  over  that  in  another  will  de- 
pend to  a  slight  extent  only  upon  inherent  capacity,  but  in 
much  greater  part  upon  a  disturbed  nutrition  dependent  on 
an  associated  lesion.  In  case  of  a  reflex  disorder,  then,  we 
must  look  for  additional  cause  in  the  way  of  a  predisposition. 
In  the  majority  of  cases  actual  experience  will  show  that 
predisposition  results  from  a  lesion  in  the  region  of  the  source 
of  nutrition  for  the  organ.  Hence  in  case  of  the  palpitation 
resulting  from  uterine  disorder  a  lesion  should  be  found  in 
the  region  of  innervation  to  the  heart,  or  in  those  structures 
which  may  directly  affect  the  heart.  And  such  is  the  case. 
If  our  contention  be  valid  the  reflex  impulse  is  but  the  exciting 
cause,  the  lesion,  the  predisposing;  neither  alone  being  suffi- 


84  PRINCIPLES   OF   OSTEOPATHY. 

cient  to  destroy  the  cardiac  equilibrium  but  acting  conjointly 
are  able  so  to  do. 

It  is  a  question  whether  a  large  number  of  so-called  re- 
flex disorders  should  be  considered  reflex  except  in  the  manner 
suggested  above.  The  occipital  headache  from  uterine  dis- 
placement will  much  more  likely  occur  if  there  be  a  local 
lesion  deranging  the  cephalic  circulation;  the  "bilious"  head- 
ache resulting  from  gastric  disorder  will  usually  present  cer- 
vical lesion  sufficient  to  cause  the  disturbance  to  appear;  even 
the  vomiting  of  pregnancy  is  often  in  direct  proportion  to  the 
abnormal  previous  condition  of  the  stomach.  Hence  let  none 
rest  content  with  the  diagnosis  of  a  "reflex  effect."  Prove 
that  the  local  structural  conditions  are  normal  before  sen- 
tencing the  reflex  mechanism  as  the  sole  cause  for  the  dis- 
turbance. 

THE  CAUSES  OF  LESIONS. 

For  purposes  of  convenience  we  may  classify  the  causes 
of  lesions  into  external  or  environmental  and  internal.  Among 
the  former  the  most  common  is  mechanical  violence  such  as  a 
blow,  a  fall,  a  mechanical  shock  or  jar  to  the  organism  pro- 
duced in  whatever  way.  It  will  be  found  on  inquiring  into 
the  history  of  a  vast  number  of  cases  of  disease  that  the  on- 
set of  the  disorder  was  noticed  soon  after  having  suffered 
the  violence,  and  owing  to  this  fact  it  is  always  the  part  of 
wisdom  to  inquire  carefully  into  the  history  of  the  case.  These 
mechanical  causes  act  alike  in  producing  bony,  muscular,, 
ligamentous,  or  visceral  lesions.  A  prolapsed  uterus  is  often 
found  to  have  its  cause  in  a  sudden  mechanical  jarring  of  the 
body.  A  luxated  rib  is  a  common  result  of  direct  pressure 
from  without  such  as  might  occur  in  the  strenuous  periods  of 
a  football  game  or  the  less  intense  but  more  prolonged  com- 
pression of  certain  steel  braces  constituting  a  part  of  the 
wardrobe  of  the  modern  woman.  A  sudden  attempt  to  pro- 
tect one's  self  from  falling  will  account  for  a  strained  muscle, 
a  sprained  articulation,  or  a  sub -luxated  vertebra.  A  second 


THE  ETIOLOGY   OP  DISEASE.  85 

important  external  cause  is  in  that  of  temperature  change.  In 
order  that  a  thermal  condition  shall  produce  its  effect  on  re- 
sponsive tissue  it  must  be  a  sudden  change  and  usually  a  change 
from  a  higher  to  a  lower  temperature.  "While  experimental 
physiology  indicates  the  possibility  of  a  contracted  muscle 
dependent  on  a  change  from  a  lower  to  a  higher  temperature, 
little  evidence  has  been  produced  to  show  that  a  similar  con- 
dition is  produced  in  the  normal  living  human  body  under 
those  circumstances.  Lack  of  evidence  however  does  not 
prove  that  the  contraction  may  not  be  brought  about  in  the 
way  suggested.  With  regard  to  the  production  of  con- 
tractured  muscles  resulting  from  sudden  exposure  to  cold 
atmosphere  or  a  cold  draught,  all  osteopaths  are  agreed  in 
emphatic  affirmation.  In  experimental  physiology  it  can  be 
shown  that  an  isolated  muscle  so  exposed  to  cold  does  con- 
tract and  it  would  seem  altogether  reasonable  that  a  similar 
condition  should  result  in  the  case  of  the  far  more  responsive 
living,  attached  human  muscle.  While  it  is  agreed  that 
muscle  protoplasm  is  the  typical  variety  that  responds  to  a 
stimulus  by  definite  and  measurable  change  of  shape  it  is  not 
at  all  unlikely  that  other  soft  tissues  of  the  body  respond  in 
the  same  way  although  not  to  the  same  degree.  The  primary 
effect  in  point  of  time  and  importance,  then,  will  be  the  pro- 
duction of  a  muscular  lesion.  But  remembering  the  intimate 
relation  existing  between  muscles  and  other  tissues  it  is  easily 
understood  how  a  bony  or  ligamentous  lesion  may  come  about 
as  a  consequence  of  a  muscular  contracture.  A  musole  can- 
not contract  without  an  approximation  of  the  structures  to 
which  the  muscle  is  attached.  Hence  if  it  be  a  spinal  muscle 
a  vertebral  lesion  will  be  produced,  or  if  it  attaches  to  a  rib 
the  rib  will  be  depressed  or  otherwise  disturbed. 

Of  the  internal  causes  of  lesions  posture  of  the  body 
may  be  mentioned  though  perhaps  with  equal  propriety  it 
might  be  classed  under  external  causes.  Especially  is  this 
operative  in  the  case  of  children  and  young  people,  the  most 
common  form  of  lesion  which  results  being  a  curvature  of  the 


86  PRINCIPLES   OF   OSTEOPATHY. 

spine.  Any  cramped  or  distorted  position  assumed  for  long 
periods  at  a  time  will  with  a  fair  degree  of  certainty  result  in 
a  gradual  change  in  the  relation  of  parts.  The  continual 
bending  over  the  desk  at  school  is  undoubtedly  accountable 
for  numerous  spinal  disorders.  Professions  and  trades  which 
require  the  assumption  of  peculiar  positions  furnish  their 
quota  of  patients  with  characteristic  lesion.  The  dorsal  in- 
clination of  the  head  in  the  process  of  lathing  a  ceiling,  the 
stooped  position  in  shoveling,  the  stooping  of  the  compositor 
at  his  case,  and  the  anterior  lumbar  curve  assumed  in  order 
to  acquire  the  so-called  "erect  form"  are  all  illustrations  of 
the  point.  In  all  of  these  there  is  a  uniform  force  continually 
acting  in  a  definite  direction,  the  inevitable  result  being  in  the 
case  of  yielding  human  tissue,  definite  changes  in  structure. 

Nutritional  disturbances  are  internal  causes  which  com- 
prehend a  variety  of  specific  conditions  such  as  congestions, 
anaemic  states,  and  nerve  irritations.  These  in'most  cases 
are  further  dependent  upon  an  adjacent  structure  but  it  be- 
comes necessary  to  seek  for  the  cause  of  the  congestion. 
Nerve  irritation  may  initiate  changes  which  produce  muscle 
contracture  or  ligamentous  thickenings  but  the  cause  of  the 
irritation  must  be  sought  for  elsewhere.  An  overworked  organ 
through  a  resulting  hypertrophy  of  its  tissue  will  become  a 
lesion.  Not  only  will  viscera  act  as  lesions  from  congestive 
conditions  but  a  muscle  will  become  contracted  through  im- 
pulses transmitted  by  reflex  pathways  from  the  viscus.  In  prac- 
tically every  acute  case  with  which  the  osteopath  comes  in 
contact  there  will  be  found  muscle  contractures,  in  part  pri- 
mary to  the  disease,. in  part  secondary  to  it.  Is  such  a  case 
possible?  Observation  by  competent  osteopaths  indicate  that 
such  secondary  contractures  do  occur.  Is  there  any  anatomi- 
cal and  physiological  explanation  for  that  condition?  Un- 
questionably. By  the  known  anatomical  facts  of  central  as- 
sociation between  spinal  nerves  and  visceral  nerves  and  the 
known  physiological  facts  of  the  radiation  of  impulses  from  one 
part  of  the  spinal  cord  to  another,  a  reasonable  explanation  is 


THE   ETIOLOGY   OF   DISEASE.  87 

not  difficult.  Afferent  impulses  aroused  by  a  disturbed  viscus 
will  be  transmitted  and  given  up  to  the  spinal  cord  and  possi- 
bly to  the  sympathetic  ganglion,  from  both  of  which  centers 
efferent  impulses,  motor  or  vaso- motor,  pass  to  the  spinal 
muscles.  That  such  an  explanation  is  reasonable  is  further 
suggested  by  reference  to  Head's  law  relating  to  sensory 
nerves.  The  law  suggests  an  intimate  relation  between  af- 
ferent nerves  closely  connected  centrally;  and  knowing  the 
peculiarities  of  reflex  action  it  requires  little  tax  on  credulity 
to  assume  a  similarly  close  central  connection  between  an  af- 
ferent visceral  nerve  and  an  efferent  motor  nerve.  Conges- 
tion or  other  nutritional  disturbances  in  the  muscle  tissue  will 
undoubtedly  lead  to  a  contracture.  Experimental  investiga- 
tion in  the  laboratory  shows  that  weak  acids  may  be  efficient 
stimuli  to  the  contraction  and  it  is  to  be  noted  that  just  such 
a  condition  is  present  in  venous  congestion  or  in  the  fatigued 
muscle.  Venous  blood,  always  less  alkaline  than  arterial, 
becomes  appreciably  acid  under  various  circumstances  of  the 
organism,  due  to  the  presence  of  carbonic  or  sarcolactic  acid, 
the  latter  a  common  product  of  excessive  katabolism.  An 
excess  of  arterial  blood  in  a  muscle  may  be  an  efficient  stimu- 
lus because  of  increasing  its  metabolic  processes  or  because 
of  soon  becoming  of  a  venous  nature  due  to  stagnation.  This 
latter  state  may  easily  follow  from  a  disturbance  of  the  vaso- 
motor  mechanism  known  to  be  associated  with  muscles  as 
with  all  other  parts  of  the  organism.  In  fatigue  of  muscle 
from  overwork  or  other  cause  we  have  conditions  entirely 
favorable  for  the  production  of  the  special  form  of  contract- 
ure which  is  so  well  known  to  the  osteopath.  Here  the  excess 
of  katabolic  waste  including  the  sarcolactic  acid  referred  to 
may  easily  be  sufficient  to  produce  the  effect.  On  the  other 
hand  ansemic  conditions  may  easily  be  responsible  for  abnor- 
mal states  of  the  muscle  and  the  cause  of  the  lesion,  though 
this  is  perhaps  a  more  debatable  proposition. 


88  PRINCIPLES   OF  OSTEOPATHY. 


CHAPTER  V. 


ETIOLOGY  OF  DISEASE  (CON.) 
ABUSE  OF  FUNCTION. 

Osteopaths  make  no  claim  that  there  are  no  possible  dis- 
ease conditions  from  other  than  structural  perversions.  Any 
one  will  recognize  the  fact  that  by  abuse  of  any  organ  or  its 
function  departure  from  normal  action  may  result.  Indeed 
every  life  is  a  continual  fluctuation  between  a  normal  and  an 
abnormal  condition  so  that  it  becomes  evident  that  disease  is 
but  a  relative  term.  If,  as  we  recognize  is  true,  a  continued 
excess  of  carbon  dioxid  in  the  blood  constitutes  a  disease, 
shall  we  decide  that  the  amount  necessary  to  arouse  increased 
respiratory  activity  is  a  disease?  That  condition  continues 
for  an  appreciable  length  of  time  and  in  so  far  as  it  does  so 
continue  it  is  normal.  But  on  the  other  hand  it  is  a  normal 
stimulus  to  the  respiratory  activity  and  for  ordinary  purposes 
of  discussion  would  not  be  considered  disease.  The  organism 
is  able  to  adjust  its  functioning  immediately.  What  is  true 
of  the  case  of  respiration  is  true  of  the  body  as  a  whole.  The 
struggle  between  organism  and  environment  is  a  ceaseless 
one  in  which  the  organism  is  usually  triumphant,  but  there 
are  times  when  the  environment  temporarily  gains  the  su- 
premacy. In  these  cases  enough  of  a  departure  from  normal 
is  apparent  to  be  dignified  by  the  term  disease.  It  is  this 
condition  that  is  present  in  abuse  of  organ  or  its  function. 
The  excess  of  food,  the  overwork  of  muscle,  the  contaminat- 
ed air,  all  represent  what  is  foreign  to  the  organism,  and  as 
such  stimulates  it  to  an  unusual  response.  In  the  vast  major- 
ity of  cases  the  organism  will  be  victor  though  no  external 
aid  is  given.  At  least  75  per  cent  of  acute  cases  will  be  over- 
come without  treatment  of  any  kind.  In  every  case  the  full 


THE   ETIOLOGY   OF  DISEASE.  89 

responsive  power  will  be  exerted  in  the  attempt  to  overcome. 
If  the  stimulus  is  too  intense  or  prolonged,  disintegration  of 
the  organ  will  result.  The  duty  of  the  physician  in  such 
cases  is  to  secure  and  maintain  such  a  condition  of  organism 
and  environment  as  will  allow  the  fullest  freedom  to  the  re- 
sponsive power  of  the  organism.  Of  prime  importance  in 
this  connection  is  the  prevention  and  overcoming  of  secondary 
lesions.  This  with  the  additional  attention  to  ordinary  laws  of 
hygiene  and  sanitation  will  usually  suffice  to  enable  a  return 
to  the  usual  grade  of  organic  action. 

The  abuse  that  will  cause  disease  may  depend  on  oveiv 
use  in  time  relations.  That  is,  the  function  evidencing  itself 
through  too  great  a  proportion  of  the  allotted  time  to  allow 
for  repair,  will  ultimately  be  disturbed.  This  disturbance 
may  be  in  the  nature  of  a  hypertrophy  of  the  organ  that  per- 
forms the  function.  An  overused  muscle  will  become  en- 
larged as  in  case  of  the  heart  following  aortic  stenosis.  A 
liver  in  an  individual  who  constantly  overeats  will  ultimately 
be  somewhat  increased  in  size.  The  constant  abuse  of  the 
stomach  may  result  in  a  thickened  mucosa.  In  numerous  of 
these  cases  the  fact  must  be  noted  that  the  hypertrophy  is  in 
part  physiological;  for  instance  the  hypertrophied  heart  is  a 
necessity  under  the  existing  circumstances,  i.  e.,  the  aortic 
stenosis.  At  the  same  time  it  is  secured  at  the  expense  of  a 
continual  tendency  toward  the  production  of  disorder  in 
neighboring  structures,  for  instance  impaired  respiration  de- 
pendent on  lung  pressure  from  the  enlarged  heart.  Sec- 
ondly, exhaustion  will  be  a  common  result  from  abuse  in  point 
of  time.  In  the  case  of  the  enlarged  heart  so  long  as  "com- 
pensation" is  maintained,  little  difficulty  may  be  experienced, 
but  usually  the  time  comes  when  all  reserve  forces  have  been 
drawn  upon,  the  heart  is  no  longer  able  to  increase  its  sub- 
stance to  meet  the  increased  demands,  and  exhaustion  of  its 
energy  rapidly  follows.  The  gastric  glands,  continuously 
called  upon  to  do  excessive  work,  will  finally  yield  to  the  in- 
evitable and  fail  to  supply  the  requisite  amount  of  digestive 


90  PRINCIPLES   OF   OSTEOPATHY. 

fluids.  In  any  of  these  cases  a  third  condition  is  likely  to  re- 
sult, i.  e.,  that  of  atrophy.  In  this  connection  note  the  wast- 
ing of  heart  muscle  following  the  period  of  "broken  compen- 
sation," the  thinning  and  waste  of  substance  in  the  walls  of 
the  stomach,  or  the  final  condition  of  atrophy  in  an  over- 
worked liver. 

Again  the  abuse  may  be  overuse  in  intensity.  Apoplexy 
resulting  from  sudden  increase  in  blood  pressure  from  over 
exercise  of  body  or  mind  is  a  case  in  point.  An  aneurism  is 
similarly  caused.  The  excessive  lifting,  athletic  efforts 
and  the  like  may  produce  strains  and  ruptures  in  various 
of  the  body  tissues.  This  does  not  include  the  cases  where  a 
pre-existing  weakened  condition  makes  the  sudden  strain,  but 
an  immediate  or  exciting  cause,  as  for  instance,  the  usual 
arterio- sclerosis  in  those  individuals  subject  to  apoplectic 
attacks. 

Instead  of  overuse  constituting  the  abuse,  underuse 
may  result  in  a  disorder.  It  is  a  well  known  fact  that  a  mus- 
cle kept  inactive  for  a  considerable  period  will  gradually 
waste  away.  This  is  true  not  of  muscle  only.  It  seems  to 
be  a  fundamental  biological  law  that  a  structure  unused  will 
become  incapable  of  use  and  if  evolution  be  accepted  as 
proven  we  may  explain  the  gradual  disappearance  of  struct- 
ures in  man  and  other  animals  on  the  basis  of  disuse.  Note 
in  the  case  of  the  lungs  of  an  individual  who  contracts  "lazy 
habits  of  breathing",  that  they  are  much  more  susceptible  to 
disorders  than  are  those  of  him  who  breathes  naturally  and 
deeply.  The  apices  are  the  regions  of  lung  tissue  most  com- 
monly involved  in  tuberculosis  and  involved  first  in  point  of 
time.  The  apex  is  the  least  exercised  of  all  parts.  The  two 
facts  may  be  closely  associated.  Again,  proteid  food  sub- 
stances furnish  the  most  efficient  stimulus  to  the  secretion  of 
pepsin  by  the  gastric  glands.  The  consumption  of  pre-digest- 
ed,  i.  e.,  pepsinized  foods  may  constitute  a  definite  abuse 
through  furnishing  lessened  exercise  of  the  peptic  glands 
with  a  consequent  atrophy  of  those  structures. 


THE   ETIOLOGY   OF  DISEASE.  91 

Finally  we  may  speak  of  abuse  in  the  form  of  perverted 
use  of  a  function.  The  teeth  are  structures  designed  to  grind 
the  food  materials.  If  that  function  is  given  to  the  stomach, 
through  improper  mastication,  there  is  a  perverted  use  of  the 
stomach.  Life  in  an  environment  of  impure  air,  noxious 
vapors,  and  dust  particles  constitutes  an  abuse  of  the  respira- 
tory function.  According  to  the  reports  of  certain  witnesses  in 
the  recent  coal  strike  investigation  one  of  the  causes  of  the 
shortened  life  period  of  the  coal  miner  was  the  continued  in- 
halation of  coal  dust.  Numerous  postmortems  in  the  case  of 
those  who  have  worked  for  long  periods  in  an  atmosphere 
charged  with  metal  or  other  particles,  indicate  the  induration 
of  the  lungs  from  deposit  of  the  material  as  a  factor  in  the 
cause  of  death.  Mouth  breathing  is  a  perversion  and  is  ac- 
countable for  occasional  disorders  of  the  respiratory  or  upper 
digestive  channel.  The  introduction  into  the  body  through 
any  pathway,  of  a  material  foreign  to  the  organism  consti- 
tutes a  perversion.  Hence  drugs  taken  into  the  alimentary 
canal,  pathogenic  bacteria  with  their  toxins  and  all  other  forms 
of  poisoning  constitute  abuse  conditions  in  the  nature  of  per- 
verted use.  In  a  large  number  of  such  cases  the  cause  is  of 
an  exciting  character,  a  predisposition  being  present  which 
impairs  the  responsive  power  of  the  organism.  This  is  es- 
pecially true  of  micro-organisms,  a  discussion  of  which  is 
given  in  a  further  chapter. 

PREDISPOSING  AND  EXCITING  CAUSES. 

The  causes  of  disease  may  further  be  classified  in  ac- 
cordance with  their  relative  capacity  to  produce  disorder 
without  the  aid  of  any  other  factors,  into  predisposing  and 
exciting.  This  classification  is  not  an  absolute  one  but  may 
be  used  with  advantage  for  purposes  of  convenience  and 
better  understanding.  A  predisposing  cause  is  any  con- 
dition of  the  organism  or  its  environment  which,  while  not 
producing  sufficient  disorder  to  constitute  disease,  renders 
the  organism  more  susceptible  to  other  causes.  As  illustra- 


92  PRINCIPLES   OF   OSTEOPATHY. 

tions  of  such  may  be  mentioned  the  following :  in  hay  fever 
two  conditions  seem  to  be  essential  in  the  production  of  the 
characteristic  symptom,  an  irritable  condition  of  the  nasal 
mucosaand  a  specific  irritant,  e.  g.,  pollen  from  some  certain 
plant,  dust  particles,  and  the  like.  The  weakness  is  more  or 
less  continuously  present,  the  specific  irritant  only  at  special 
periods.  In  this  case  the  irritable  mucosa  with  whatever  has 
caused  that  condition,  e.  g.,  a  lesion  in  the  cervical  region, 
constitutes  the  predisposing  cause,  the  pollen  or  dust  particles 
representing  the  exciting  cause.  Neither  of  these  two  is 
capable  alone  of  producing  the  attack  but  acting  conjointly 
are  sufficient.  The  small  boy  is  noted  for  his  craving  for 
green  apples.  If  a  lesion  be  present  in  his  splanchnic  region 
and  he  indulges  the  craving,  an  attack  of  cholera  morbus  is 
the  result.  In  this  case  the  green  apple  represents  the  "last 
straw"  added  to  a  stomach  weakened  from  vasomotor  dis- 
turbance maintained  by  the  splanchnic  lesion.  A  depressed 
thoracic  region  by  limiting  the  amplitude  of  the  respiratory 
movements  renders  the  lungs  less  able  to  resist  tuberculosis 
infection,  the  tubercle  bacillus  acting  as  the  immediate  cause 
of  pulmonary  consumption,  the  former  the  predisposition  to 
the  disorder.  Pulmonary  troubles  tend  to  run  in  families.  It 
is  not  the  inheritance  of  the  specific  condition  but  the  peculiar- 
ity of  lung  or  chest  structure.  Most  reflex  disorders  are  satis- 
factorily explained  from  this  double  cause  standpoint.  For 
instance  a  common  accompaniment  of  uterine  disorder  is  pal- 
pitation of  the  heart.  Such  a  disturbed  heart  rate  is  much 
more  likely  in  an  individual  with  a  spinal  lesion  in  the  cardiac 
area  than  in  one  where  heart  control  is  not  interfered  with. 
Age,  sex,  temperament  and  race  relating  to  the  organism,  and 
climate,  season,  atmospheric  and  other  environmental  circumstances 
may  constitute  predisposing  causes  or  occasions.  It  is  com- 
mon knowledge  that  children  are  more  susceptible  than  adults 
to  measles  or  scarlet  fever,  while  arterio- sclerosis,  paralysis 
agitans,  and  numerous  other  disorders  only  affect  the  adult 
or  aged.  The  peculiar  condition  of  the  organism  at  these 


THE   ETIOLOGY   OF    DISEASE.  93 

different  periods  constitutes  a  predisposition.  The  Negro 
race  is  more  susceptible  to  tuberculosis  and  less  so  to  yellow 
fever  and  malaria  than  is  the  Caucasian ;  and  this  by  virtue 
of  some  inherent  difference  in  the  organism  which  is  without 
satisfactory  explanation.  Climate  is  accountable  for  special 
disorders.  Catarrhal  affections  of  the  respiratory  tract  are 
common  in  cold,  damp,  and  changeable  localities,  while 
typhoid  and  other  fever  conditions  are  associated  with  late 
summer  and  autumn,  in  each  case  predisposing  to  the  onset 
of  the  disease  through  the  agency  of  various  exciting  stimuli. 
A  point  to  be  noted  in  this  connection  is  the  fact  of  what 
we  may  conveniently  speak  of  as  a  reversibility  of  causes. 
That  is,  a  lesion  which  in  one  set  of  circumstances  constitutes 
a  predisposition,  may  in  another  be  an  excitant.  Note  the 
case  in  hay  fever.  An  individual  manifests  a  lesion  in  the 
cervical  region.  Passing  to  that  period  of  the  season  when 
pollen  is  plentiful  the  attack  is  initiated.  In  this  case  the 
lesion  is  predisposing,  the  pollen  exciting  to  the  disorder. 
Another  individual  continuously  living  in  a  pollen-laden 
atmosphere  is  unaffected  thereby.  But  a  lesion  is  produced 
when  the  attack  at  once  supervenes.  Thus  predisposition  and 
excitant  have  been  reversed.  Climatic  condition  may  be  the 
excitant  or  a  predisposing  cause.  In  the  first  case  a  lesion 
is  present  rendering  the  nasal  tissues  susceptible  to  the  in- 
fluence of  sudden  changes  of  temperature  the  latter  being  the 
excitant  of  the  disorder ;  on  the  other  hand  an  individual 
living  in  a  changeable  climate  is  predisposed  to  catarrhal  dis- 
orders by  virtue  of  the  environment,  the  catarrhal  condition 
itself  being  excited  on  the  production  of  a  specific  lesion.  An 
individual  with  a  normal  splanchnic  region  may  continually 
abuse  his  stomach  by  overeating  and  still  no  gastric  dis- 
turbance result  but  on  the  production  of  a  lesion  disorder  soon 
becomes  manifest ;  on  the  other  hand  an  individual  with  a 
lesion  in  his  splanchnic  region  may  show  no  marked  evidence 
of  stomach  trouble  but  on  abuse  of  his  stomach  by  dietetic 
errors  disease  occurs. 


94  PRINCIPLES   OF  OSTEOPATHY. 

It  is  to  be  noted  further  that  while  a  predisposing  cause 
of  disease  usually  will  not  be  sufficient  to  produce  the  disease, 
an  excitant  may  produce  it  with  or  without  the  addition  of  the 
other  factor.  While  it  is  much  more  likely  that  disease  will 
result  from  the  eating  of  green  apples  in  the  case  of  a  child 
who  shows  specific  splanchnic  lesion  experience  would  indi- 
cate that  the  green  apples  alone  is  an  efficient  cause. 

Finally  it  is  to  be  noted  that  in  a  large  number  of  disease 
conditions  of  any  permanency  in  time  they  are  dependent  not 
on  a  single  cause  but  upon  numerous  factors  in  which  numer- 
ous lesions  and  numerous  forms  of  abuse  may  be  concerned 
in  the  various  relations  of  predisposition,  predisposing  occa- 
sions, and  exciting  causes.  (For  an  excellent  discussion  of 
"Summation  of  Causes  in  Disease  and  Death"  see  October, 
1902  issue  of  the  Journal  of  the  American  Osteopathic  Asso- 
ciation, by  E.  R.  Booth,  Ph.  D.,  D.  O.) 

THE  GERM  THEORY  OF  DISEASE. 

It  seems  proper  at  this  time  to  discuss  a  problem  in  rela- 
tion to  disease  which  has  in  recent  years  assumed  extreme 
importance.  The  germ  theory  of  disease  is  not  at  all  a  new 
explanation  of  disease  conditions,  for  ever  since  the  inven- 
tion of  the  compound  microscope  in  the  middle  of  the  seven- 
teenth century  the  fact  that  small  forms  of  life  were  associ- 
ated with  certain  diseases  has  been  known ;  and  not  only  was 
this  association  known  but  shortly  following  the  discovery  of 
the  micro 'Organisms  the  doctrine  of  a  causal  relation  be- 
tween such  micro-organisms  and  the  disease  was  promulgated 
and,  as  suggested  by  Abbot,  amounted  almost  to  a  germ- 
mania.  But  like  numerous  other  facts  and  theories  based 
upon  those  facts  this  was  practically  lost  sight  of  until  late 
in  the  nineteenth  century  when  it  was  again  revived  by 
numerous  investigators  of  world -renown  among  whom  the 
names  of  Pasteur,  Klebs,  and  Koch  stand  pre-eminent.  These, 
with  others,  placed  the  theory  upon  fairly  sure  ground  in 
showing  by  methods  to  which  no  objections  could  be  raised 


THE  ETIOLOGY   OF  DISEASE.  95 

that  in  certain  cases  there  is  such  a  definite  relation  be- 
tween the  pathologic  condition  and  the  presence  of  the 
micro-organism.  The  question  is  not  yet  entirely  settled  as 
to  the  nature  of  that  relation.  Is  the  disease  as  it  exists  respon- 
sible for  the  presence  of  the  micro-organism  or  do  the  bacteria  pro- 
duce the  pathologic  condition?  In  accordance  with  these  two 
ideas  the  micro-organisms  have  been  classified  into  the 
saprophytic,  or  those  which  live  only  upon  refuse  matter  and 
are  hence  beneficial  to  the  organism ;  and  pathogenic,  or  those 
which  by  virtue  of  some  deleterious  action  definitely  produce 
the  disease  condition.  Doctor  Still  has  insisted  that  all  are 
of  the  former  class  and  compares  them  to  buzzards  whose 
function  in  the  larger  world  than  man  is  to  render  dead  and 
decaying  material  incapable  of  further  harm.  In  this  as- 
sumption we  are  personally  convinced  that  he  is  essentially 
correct,  and  that  this  view  is  not  foreign  to  that  of  a  large 
number  of  the  best  thinkers  and  closest  investigators  of  today 
is  becoming  more  and  more  evident. 

Admitting  for  the  time  that  certain  forms  of  bacteria  to 
produce  disease  the  question  arises  as  to  the  manner  in 
which  it  is  effected.  It  has  been  explained  on  the  theory 
little  supported  by  fact,  that  the  micro-organism  abstracted 
the  nutritive  material  and  thus  robbed  the  tissues  of  their 
source  of  supply;  another  explanation  is  that  by  their  rapid 
multiplication  a  direct  mechanical  blocking  of  the  channels  and 
spaces  of  the  body  was  produced  with  the  resulting  abnormal 
tissue  changes;  a  further  suggestion  of  some  value  is  that 
the  bacterium  directly  attacks  and  destroys  the  body  cells 
including  but  not  limited  to  the  white  corpuscles ;  the  explan- 
ation at  present  given  and  one  that  more  nearly  meets  the 
requirements  of  all  cases  is  based  on  the  fact  that  in  the 
rapid  propagation  of  the  organism  toxins  are  formed  which 
act  in  a  definitely  destructive  way  upon  the  tissue  cells.  In 
so  far  as  the  bacterium  is  responsible  for  disease  or  compli- 
cates the  condition  already  present  any  one  or  more  of  these 


96  PRINCIPLES   OF  OSTEOPATHY. 

several  explanations  may  be  correct  but  the  last  is  undoubt- 
edly of  paramount  importance. 

Admitting,  then,  that  inasmuch  as  the  micro-organisms 
are  present  in  disease  and  the  toxins  are  produced  which  are 
destructive  to  living  tissue,  it  is  yet  sufficient  to  say  that  the 
micro-organism  is  the  essential  cause  of  the  disorder.  While 
the  germ  theory  was  being  pressed  into  service  there  were 
individuals  who  insisted  that  bacteria  were  already  present 
in  the  tissue  of  normal  individuals.  The  germ  theorists  them- 
selves in  attempting  to  show  the  fallacv  of  this  position  have  estab- 
lished a  firm  foundation  for  the  claim  that  the  micro-organism  is 
not  of  itself  sufficient  cause.  Note  the  significance  of  the  fol- 
lowing statement  from  Abbot's  Principles  of  Bacteriology: 
"Under  careful  precautions  against  which  no  objections 
could  be  raised  the  experiments  of  Billroth  and  Tiegel  were 
repeated  by  Pasteur,  Burdon,  Sanderson,  andKlebs,  but  with 
failure  in  every  instance  to  demonstrate  the  presence  of  bac- 
teria in  the  healthy,  living  tissue".  Why  are  they  not  present 
in  healthy,  living  tissue?  We  believe  the  only  answer  possible 
s  that  absolutely  healthy  tissue  is  incompatible  with  the  pro- 
pagation of  the  bacterium.  The  following  facts  are  also  sig- 
nificant :  in  any  epidemic  of  diphtheria  there  is  little  difficulty 
in  demonstrating  the  presence  of  the  pharyngeal  mucous 
membrane  of  normal  individuals,  the  Klebs-Loffler  bacillus; 
the  micro-coccus  lanceolatus  is  present  in  the  sputum  of  many 
individuals  not  affected  with  pneumonia;  even  in  cholera 
asiatica  unaffected  individuals  may  show  the  presence  of  the 
comma  bacillus  of  Koch  in  the  mucous  of  the  intestinal  canal. 
Why  are  not  these  affected?  Why  is  not  every  individual 
stricken  with  the  disease  that  passes  through  the  community 
as  an  epidemic?  The  only  possible  answer  is  that  they  are 
immune  and  immunity  proves  nothing  less  than  that  the  bacterium 
cannot  be  a  sufficient  cause  of  disorder. 

A  few  suggestions  regarding  the  nature  of  immunity 
may  not  be  out  of  place.  It  is  spoken  of  as  being  natural  or 
acquired.  For  instance  in  the  case  of  the  Negro  comparative 


THE  ETIOLOGY   OF   DISEASE.  97 

immunity  to  yellow  fever  and  malaria  is  noted ;  many  indi- 
viduals are  never  attacked  with  the  small  pox  virus  although 
they  are  continually  exposed.  These  have  a  natural  immun- 
ity. But  it  is  further  noticed  that  in  many  of  the  infectious 
diseases  one  attack  renders  the  individual  immune  to  a  sec- 
ond, in  which  case  the  immunity  has  been  acquired.  There 
are  three  principle  factors  which  secure  to  the  individual 
such  immunity.  The  first  is  the  phagocytic  action  first  empha- 
sized by  Sternberg  and  later  by  Metchnikoff.  This  con- 
sists in  the  independent  action  of  the  white  blood  corpuscles 
by  virtue  of  which  it  is  enabled  to  flow  around  and  digest  the 
bacterium,  in  which  case  there  is  a  germicidal  action;  a  sec- 
ond factor  is  the  antitoxic  conditions  secured  by  cell  secre- 
tions which  render  the  micro-organism  incapable  of  poison- 
ing the  organism ;  and  last  the  blood  and  tissues  are  aseptic 
partly  because  of  their  alkalinity  which  is  sufficient  to  render 
conditions  unfavorable  for  the  development  of  most  of  the 
pathogenic  micro-organisms  and  partly  because  of  the  pres- 
ence of  nucleinic  acid  which  is  also  unfavorable.  These 
three  factors  are  obviously  dependent  upon  normal  blood  and 
hence  it  is  that  the  blood  is  said  to  be  aseptic,  germicidal,  and 
antitoxic.  In  case  these  several  factors  are  not  present  in 
their  full  efficiency  and  the  individual  succumbs  to  a  first 
attack,  this  of  itself  usually  is  a  sufficient  stimulus  for  pro- 
ducing the  full  efficiency  of  each  factor  and  hence  no  second 
attack  is  probable. 

Meltzer,  quoted  by  Vaughan  and  Novy  in  their  work  on 
* 'Cellular  Toxins",  sums  up  the  organism's  defense  against 
bacteria  in  these  words:  "I  maintain  in  the  first  place  that 
in  the  struggle  against  bacteria  the  defense  of  the  body  is  not 
carried  on  exclusively  or  chiefly  by  a  single  element.  It  is 
neither  the  body  fluids  nor  the  leucocytes  nor  the  other  cells 
alone  which  can  claim  the  exclusive  merit  of  maintaining  the 
health  of  the  body,  but  each  and  every  one  of  them  has  its 

variable  share  in  attaining  the  desired  end Let  us 

take  as  an  illustration  the  protection  of  the  conjunctival  sac. 


98  PRINCIPLES   OP   OSTEOPATHY. 

It  is  nearly  in  direct  contact  with  the  air  and  we  might  expect 
to  find  there  an  extensive  bacterial  settlement.  Nevertheless 
Lachowitz  and  Bujwid  found  that  in  69  per  cent  of  cases  the 
conjunctiva  was  perfectly  sterile.  The  factors  which  accom- 
plish this  sterility,  or  at  least  comparative  sterility,  of  bacte- 
ria are :  The  reflex  which  causes  the  closure  of  the  lids  at  the 
approach  of  dust  (the  carrier  of  bacteria);  the  blinking 
which  occurs  regularly  a  few  times  in  a  minute,  which  in 
conjunction  with  the  lachrymal  moisture  throws  out  again 
mechanically  the  already  landed  bacteria;  and  finally,  the 
bactericidal  effects  of  the  tears  destroys  the  balance  of  the 
invaders.  Or  let  us  take  the  respiratory  organ  from  the 
larynx  down  to  the  respiratory  tissues  including  the  corres- 
ponding lymph  glands  Through  this  path  the  out- 
side world  stands  in  an  intimate  relation  to  the  interior  of  the 
body,  inasmuch  as  the  air  column  is  separated  from  the 
lymphatics  and  capillaries  of  the  lungs  merely  by  a  single 
layer  of  the  very  thin  epithelium  of  air  cells.  Even  the  se- 
rous cavities  are  separated  from  the  lymph  spaces  by  thicker 
layers.  This  arrangement  is  of  course  indispensable  for  the 
proper  exchange  of  the  blood  gases  with  the  air.  But  what 
prevents  the  bacterial  invasion  of  the  interior  of  the  body  by 
this  open  and  direct  way?  Moreover,  most  of  the  writers 
agree  that  trachea,  bronchi,  and  lung  tissue  of  healthy  ani- 
mals are  entirely  sterile.  In  a  number  of  rabbits  under 
morphine  anaesthesia  I  found  all  these  parts  to  be  sterile.  If 
one  vagus  or  a  laryngeal  branch  was  cut  then  the  upper 
part  of  the  trachea  contained  bacteria  but  not  .the  lung. 
When  both  vagi  were  cut,  then  of  course  the  lungs,  too,  were 
invaded.  Jundell  reported  recently  that  by  means  of  a 
special  device  he  was  able  to  test  the  human  trachea  and 
found  that  in  the  majority  of  healthy  cases  the  region  below 
the  glottis  proved  to  be  sterile.  What  protects  this  path?  In 
my  opinion  the  result  is  accomplished  by  the  cooperation  of 
the  following  factors :  The  tortuous  part  of  the  respiratory 
path  lying  above  the  glottis  removes  perhaps  the  greatest 


THE  ETIOLOGY  OF  DISEASE.  99 

part  of  the  bacteria  contained  in  the  inspired  air  column  and 
the  remaining  number  is,  under  normal  conditions,  just  small 
enough  to  be  disposed  of  by  the  factors  present  below  the 
larynx.  Bacteria  which  pass  the  glottis  are  either  carried 
back  outside  of  the  glottis  from  the  trachea  and  the  bronchi 
by  the  steady  movements  of  the  cilia  of  the  epithelium,  or, 
if  the  germs  are  carried  in  the  center  of  the  air  column  down 
to  the  air  cells,  they  quickly  penetrate  the  thin  epithelial 
layer  and  are  immediately  in  the  reach  of  the  lymph  glands, 

which  take  good  care  of  them In  connection  with 

the  respiratory  path,  I  would  like  to  recall  here  the  interesting 
fact  that  both  canals  which  lead  farthest  to  the  innermost 
of  the  body,  that  is,  the  respiratory  and  the  female  genital 
canal  (which  latter  terminates  in  the  peritoneum)  have  ciliat- 
ed epithelium,  the  movements  of  the  cilia  being  outward  and 
are  as  far  as  the  epithelium  extends,  entirely  or  nearly 
sterile." 

In  general,  then,  we  arrive  at  the  conclusion  to  which 
the  old  school  physicians  must  come  and  in  goodly  number 
are  already  coming,  that  first,  assuming  that  the  bacteria  may 
be  able  to  gain  access  to  the  body  substance,  vitiated  tissue  is  a 
necessary  prerequisite  before  the  bacterium  may  excite  the 
specific  disorder,  and  that  second,  the  treatment  must  be  di- 
rected to  overcome  the  cause  of  this  vitiated  tissue,  which  is  usually 
a  lesion  or  abuse,  and  to  assist  the  organism  in  keeping  up 
its  strength  to  overcome  the  bacterium  or  its  products  which 
constitute  the  exciting  cause. 

It  would  seem  therefore  that  the  anathemas -hurled  at  the 
germ  theory  advocates  by  certain  osteopaths  are  entirely  un- 
called for.  The  position  of  osteopathy  is  impregnable  regard- 
less of  the  ultimate  demonstration  of  the  exact  relation  be- 
tween bacteria  and  disease.  If  .it  be  shown  that  all  such 
micro-organisms  are  simply  associated  and  not  causal  factors, 
well  and  good.  If  the  causal  relation  be  established,  it  is  no 
more  true  of  them  than  of  numerous  other  elements  of  en- 
vironment that  they  may  promote  disease.  Continued  life  in 


100  PRINCIPLES   OF   OSTEOPATHY. 

an  atmosphere  of  dust  certainly  will  cause  disorder  through 
abuse  of  the  organs  of  respiration.  An  environment  of  ex- 
cessive microscopic  life  constitutes  an  abusing  factor  in  the 
same  way.  The  organism  will  be  successful,8o  far  as  success 
is  at  all  possible,  as  long  as  the  machinery  through  which  life 
manifests  itself  is  kept  in  its  structural  integrity. 


LEGE  0  ior 

FH'.'SfCf/: 

THE   DIAGNOSIS   OF   DISEASE.  101 

CHAPTER  VI, 


THE  DIAGNOSIS  OF  DISEASE. 
THE  SYMPTOM. 

Diagnosis  consists  in  the  determination  of  the  location 
and  nature  of  disturbed  conditions.  The  osteopath  recognizes 
the  value  of  symptoms  in  that  diagnosis.  A  symptom  or 
group  of  symptoms  does  not  constitute  disease  but  is  only  the 
evidence  that  disease  exists.  That  rule  of  practice  is  a  con- 
fession of  failure  to  trace  the  symptom  to  its  cause,  to  treat 
the  symptoms  as  they  arise.  It  is  only  in  occasional  cases 
that  it  is  necessary  or  advisable  to  treat  symptoms  and  even 
then  it  is  but  incidental.  The  symptom,  is  an  effect  and  a  logi- 
cal, a  legitimate,  and  under  the  circumstances  a  physiological 
effect.  It  is  as  much  a  matter  of  physiology  that  the  heart 
rate  should  be  increased  when  peripheral  resistance  is  at 
fault  as  that  the  heart  should  maintain  a  normal  rate  under 
normal  conditions  of  peripheral  resistance.  Pain  is  a  physio- 
logical condition  under  the  circumstances  of  pressure  or  other 
cause  of  sensory  irritation,  and  it  is  markedly  true  of  pain, 
that  by  its  presence  protection  to  the  organism  is  secured. 
In  the  first  place  pain  is  a  warning  to  the  consciousness  of 
the  individual  that  something  is  wrong;  second,  the  location 
of  the  pain  together  with  the  transference  of  the  sensation 
gives  fairly  accurate  location  of  the  disturbance;  third,  pain 
in  numerous  cases  enforces  rest,  thereby  securing  better  op- 
portunity for  organic  repair;  and  fourth  the  pain  condition 
by  causing  directly  or  indirectly  or  reflexly  increased  activity 
of  other  parts  of  the  body  may  further  aid  in  processes  of 
repair. 

In  the  case  of  high  temperature  we  have  a  condition 
that  is  directly  advantageous  to  the  organism  in  many  in- 
stances. We  know  that  in  numerous  fever  conditions  certain 


I  I  ' 


102  PRINCIPLES   OF  OSTEOPATHY. 

pathogenic  micro-organisms  play  an  important  role,  not 
necessarily  in  acting  as  the  original  cause  for  the  disorder, 
but  at  least  in  complicating  the  condition.  By  laboratory  ex- 
periment and  clinical  observation  it  is  found  that  with  many 
forms  of  bacteria  a  high  temperature  is  directly  antagonistic 
to  their  development.  Hence,  the  high  temperature,  while  a 
definite  symptom  of  a  disorder  is  in  addition  a  definite  pro- 
tection to  the  individual.  In  an  equal  degree  the  profuse 
sweat  which  is  often  associated  with  fever  cases  is  an  ar- 
rangement whereby  a  temporary  respite  is  given  to  the  patient 
from  the  great  discomfort  due  to  the  temperature.  In  the 
evaporation  of  the  perspiration,  the  patient  is  temporarily  re- 
lieved. In  some  cases,  as  in  acute  articular  rheumatism  the 
sweat  is  distinctly  acid,  and  as  such  represents  an  excretion 
material.  This  suggests  that  the  profuse  perspiration  is  an 
aid  to  body  purification.  The  chill,  also  often  found  in  con- 
nection with  various  acute  cases  represents  a  physiological 
principle.  If  a  case  of  malarial  fever  be  examined  just  at 
the  beginning  of  the  period  of  the  chill,  it  will  be  found  that 
the  temperature  of  the  body  is  below  the  normal.  If  observa- 
tion be  made  shortly  after  the  chill  period,  or  even  before  that 
period  ceases,  a  considerable  increase  in  the  temperature  will 
be  noted.  Hence,  the  chill  is  a  method  for  increased  heat 
production  —  a  thing  necessary  under  the  circumstances.  We 
know  that  most  of  the  body  heat  results  from  oxidation  pro- 
cesses taking  place  in  active  muscle  tissue.  In  'the  chill  we 
have  a  rapid  contraction  and  relaxation  of  the  muscle  tissues 
of  the  body  with  the  consequent  elaboration  of  heat.  Accord- 
ing to  Lowy,  (Schafer's  Physiology)  the  simple  process  of 
shivering  may  increase  the  metabolism  of  the  tissue  100  per 
cent.  Since  the  chill  is  but  an  exaggeration  of  the  shiver, 
the  explanation  of  the  increase  in  temperature  becomes  obvi- 
ous. In  the  convulsion  we  have  still  another  condition  where 
it  is  probably  true  that  a  physiological  purpose  is  fulfilled. 
Dr.  Still  has  repeatedly  emphasized  the  fact  that  the  muscular 
spasm  is  but  nature's  effort  to  produce  a  re-distribution  of  the 


THE   DIAGNOSIS   OF  DISEASE.  103 

forces  and  fluids.  Note  the  extreme  quiet  that  follows  the 
epileptic  spasm.  For  several  hours  there  is  deep  sleep  dur- 
ing which,  recuperation  is  in  progress. 

Vomiting  and  diarrhoea  are  symptoms  indicating 
that  there  is  disturbance  to  the  nerve  terminals  in  the  diges- 
tive tract.  But  both  are  physiological.  By  the  vomiting 
process  the  organism  rids  itself  of  material  which  if  allowed 
to  pass  into  the  intestinal  canal  would  create  further  disorder; 
while  the  rapid  peristalsis  associated  with  the  diarrhoea  car- 
ries onward  material,  which,  having  gained  entrance  to  the 
canal  is  directly  irritant.  By  this  increased  motion  absorp- 
tion of  the  irritating  material  is  naturally  lessened,  and 
hence,  a  definite  protection  is  provided.  The  anorexia  which 
is  likely  to  be  associated  with  both  these  conditions,  is  a  dis- 
tinct protection  in  that  it  militates  against  taking  into  the 
alimentary  canal  additional  material  before  the  canal  has 
cleansed  itself  of  the  irritant  and  before  the  assimilative  pro- 
cesses are  again  in  condition  to  function  properly.  In  such  a 
case,  the  absence  of  desire  for  food  should  be  sufficient  warn- 
ing to  refrain  from  partaking.  The  warning  is  often  in- 
creased by  a  definite  nausea  which  is  produced  by  the  mere 
sight  or  thought  of  food.  Needless  to  say,  the  warn- 
ing should  be  heeded,  and  yet,  as  a  result  of  years  of 
false  teaching,  there  are  many  who  utterly  ignore  the  warn- 
ing and  insist  on  forcing  food  materials  upon  a  proper  rebel- 
lious stomach. 

The  rapid  respiration  in  pneumonia  is  another  typical 
symptom.  It  undoubtedly  is  a  favorable  condition  under  the 
circumstances.  For  in  this  disorder  one  lobe  of  the  lung 
becomes  incapacitated  because  of  an  infiltration  into  the  air 
sacs  and  bronchioles  of  a  material  through  which  air  cannot 
pass.  As  a  result  the  lobe  becomes  solidified  and  compara- 
tively little  movement  is  possible.  But  the  demand  for  oxy- 
gen is  just  as  great  as  before,  hence,  in  order  to  keep  up  a 
proper  supply  other  parts  of  the  lung  must  be  over  active. 
Hence,  by  this  hyper- activity  the  organism  is  protected 


104  PRINCIPLES   OF   OSTEOPATHY. 

against  a  deficiency  of  oxygen  that  would  otherwise  result. 
In  a  similar  manner  increased  activity  of  the  heart  muscle  is 
called  for  when  a  valvular  deficiency  occurs.  In  order  to  keep 
up  a  normal  circulation  with  deficient  valves,  there  must  be 
an  exaggerated  heart  action.  Clinical  experience  shows  this 
to  be  the  case.  And  not  only  does  the  heart  increase  its 
rapidity  but  it  also  increases  its  substance,  purely  a  matter 
of  accommodation  resulting  from  the  excess  of  action. 
Hence  hypertrophy  of  the  heart,  while  a  symptom  of  organic 
cardiac  disorder,  is  also  a  definite  protection  against  failure 
of  the  circulation — an  evil  much  greater  than  an  enlarged 
heart. 

Glycosuria,  as  it  is  found  in  diabetes  is  a  definite 
symptom  of  liver  or  pancreatic  disorder.  It  ought  to  be  pre- 
sent in  such  a  case.  In  fact  the  rather  abrupt  cessation  of 
this  symptom  in  a  serious  case  of  disease  is  a  cause  for 
alarm.  For,  if  the  sugar  is  present  in  excess  in  the  blood, 
various  fermentation  processes  will  be  inaugurated  with  the 
production  of  acetone  and  other  substances  favorable  to  the 
development  of  diabetic  coma.  When  the  sugar  begins 
to  accumulate  in  the  blood  it  is  the  function  of  the  kidney 
to  throw  it  out,  and  so  long  as  this  is  kept  up  the  disorder 
may  not  be  a  serious  one.  The  failure  of  the  kidney 
to  excrete  is  the  cause  for  alarm.  Associated  with  the  ex- 
cess of  sugar  in  the  urine  there  is  an  increased  quantity  of 
the  latter  excreted,  as  much  as  twenty  pints  or  more  has 
been  noted.  Under  the  circumstances  this  is  necessary.  In 
order  to  keep  the  excess  of  sugar  in  solution,  fluid  must  be 
supplied.  The  greater  the  amount  of  sugar  present,  the 
greater  will  be  the  amount  of  water  excreted  with  it  to  hold 
it  in  solution.  In  this  case,  the  symptom  is  an  undoubted 
protection. 

In  many  inflammatory  conditions  there  are  certain 
appearances  which  suggest  a  definite  protective  action.  It 
has  been  asserted  with  a  good  degree  of  evidence  that  the 
serous  exudate  in  an  inflamed  area  is  a  factor  that  tends  to 


THE   DIAGNOSIS   OF   DISEASE.  105 

reduce  the  pain  condition  and  assist  in  the  healing  process. 
In  the  case  of  an  inflammation  of  a  mucous  surface,  as  in  all 
catarrhal  conditions, there  is  an  excess  of  mucous  secreted.  This 
is  unquestionably  in  most  cases  a  decided  protection.  The  ex- 
cessive blowing  of  the  nose  in  an  ordinary  acute  nasal  catarrh 
is  a  detriment  from  this  very  fact.  If  the  material  is  per- 
mitted to  remain  in  contact  with  the  mucosa,  the  healing 
process  will  be  hastened.  In  croupous  inflammations  such  as 
diphtheria,  the  removal  of  the  membrane  is  decidedly  contra- 
indicated,  unless  it  forms  so  rapidly  and  in  such  amount  as  to 
offer  serious  obstruction  to  respiration.  It  is  undoubtedly,  as 
indicated  by  clinical  experience  and  by  abstract  reason,  a 
real  protection  to  the  raw  surface  which  is  exposed  on  remov- 
ing the  membrane. 

Cases  might  be  multiplied  indefinitely  where  a  peculiar 
appearance  usually  mentioned  as  a  symptom,  is  not  only  the 
latter,  but  also  is  a  protective  means  employed  by  nature. 
Not  that  every  symptom  is  necessarily  a  benefit  to  the  organ- 
ism or  that  it  is  evidence  that  the  latter  is  making  the  attempt 
to  overcome  the  disorder.  In  fact  we  know  that  to  all  appear- 
ances there  are  certain  secondary  changes  that  arise  which 
are  a  disadvantage  to  the  organism.  But  there  are  cer- 
tainly enough  cases  where  a  real  benefit  is  derived  to  warrant 
the  greatest  of  care  in  determining  whether  a  symptom  should 
be  combatted.  Certain  it  is  that  the  rule  of  practice  to  "treat 
the  symptoms  as  they  arise"  has  no  place  in  the  philosophy 
or  practice  of  the  osteopath. 

While  it  is  thus  true  that  in  many  cases  the  symptom  has 
a  definite  value  aside  from  the  fact  that  it  is  a  key  to  the 
nature  and  location  of  the  disease,  it  is  with  reference  to  this 
latter  consideration  that  the  physician  finds  it  of  decided 
practical  value.  Disease  in  large  part  is  determined  by 
symptoms,  and  we  may  define  a  symptom  as  any  unusual 
manifestation  in  structure  or  function  that  suggests  disease. 
The  symptom,  in  case  it  is  one  noted  only  in  the  sensations 
of  the  patient,  may  be  subjective,  or  where  noted  by  physician 

8 


106  PRINCIPLES  OF  OSTEOPATHY. 

or  other  observer,  is  objective.  As  an  instance  of  the  former, 
pain  is  typical ;  of  the  latter  the  coated  tongue  in  digestive 
disturbances,  the  contractured  muscle  in  spinal  lesions,  or 
albuminuria  in  case  of  nephritis. 

Of  the  classes  of  symptoms,  subjective  and  objective,  the 
latter  is  the  one  relied  upon  for  determining  the  details ;  the 
former,  although  customarily  first  used  in  point  of  time,  is 
unsatisfactory.  This  is  true  because  the  subjective  symptoms 
are  subjective.  Feelings  are  unreliable  signs.  The  location  of 
the  disorder  may  be  far  remote  from  that  which  is  apparently 
indicated  by  the  sensation.  The  further  fact  that  in  numer- 
ous cases  patients  are  unable  to  locate  the  sensation  or  are 
unable  to  give  an  accurate  description  of  its  ntaure,  increases 
the  difficulty  in  the  way  of  a  satisfactory  diagnosis  from  sub- 
jective symptoms.  On  the  other  hand  the  conditions  that  can 
be  seen  and  felt  objectively  by  the  physician  constitute  fairly 
accurate  indications  of  the  disorder,  while  the  tenderness  on 
pressure  which  is  manifest  on  physical  examination  gives  quite 
accurate  data  for  legitimate  conclusions. 

METHODS  OF  EXAMINATION. 

The  methods  of  examination  objectively  are  those  in  use 
by  physicians  of  all  schools  although  the  osteopath  empha- 
sizes one,  palpation,  above  all  the  others.  First  in  point  of 
time  is  the  method  by  inspection,  which  consists  in  observ- 
ing various  changes  in  the  appearance  of  the  body,  its  func- 
tions and  its  products,  by  the  sense  of  sight;  for  instance  a 
coated  tongue ',  a  sallow  complexion,  and  a  high  colored  urine  are 
seen;  by  inspection  lesions  are  determined,  at  least  in  general, 
as  in  the  case  of  the  carriage  of  the  head  in  torticollis,  the  in- 
version of  the  toe  in  a  dorsum  dislocation  of  the  hip,  or  a 
contractured  muscle  and  deviated  spinous  process  in  a  spinal 
disorder. 

Palpation  is  the  second  method  in  point  of  time  but  first 
in  point  of  importance  and  consists  in  determining  conditions 
by  the  sense  of  touch.  For  instance  by  palpation  we  may 


THE   DIAGNOSIS   OF  DISEASE.  107 

note  an  increased  cardiac  impulse,  a  difference  in  the  respira- 
tory movement  of  the  two  sides  of  the  chest,  a  ttimor  of  the  ab- 
domen, a  high  temperature  in  fever  conditions,  a  contractured 
muscle,  a  luxated  rib,  or  a  limited  movement  in  articular  struc- 
tures, and  by  pressure  upon  a  part,  though  not  by  the  sense 
of  touch  of  the  diagnostician,  differences  in  sensory  conditions 
of  the  patient  may  be  determined.  Osteopaths  pride  them- 
selves upon  the  delicacy  of  their  sense  of  touch  and  it  is  well 
they  should,  because  by  no  method  can  the  lesion  be  deter- 
mined so  satisfactorily  or  certainly  as  by  palpation.  If  one  of 
the  various  methods  should  be  developed  at  the  expense  of 
others  that  one  is  palpation.  It  is  characteristic  of  the 
founder  of  osteopathy  that  he  makes  use  of  palpation  almost 
to  the  exclusion  of  other  methods,  and  his  ability  to  detect 
structural  changes  with  little  difficulty  by  his  sense  of  touch 
is  common  knowledge.  That  there  is  large  possibility  of  de- 
veloping that  sense  will  be  admitted  by  all,  but  to  the  osteo- 
pathic  practitioner  the  fact  becomes  more  and  more  striking 
as  his  experience  and  observation  extend  over  a  larger 
period  and  a  wider  field. 

A  third  method  of  objective  diagnosis  is  percussion. 
This  consists  in  the  comparison  between  the  sounds  produced 
by  a  series  of  light  blows  over  the  normal  organ.  Every  or- 
gan or  structure  will  have  its  specific  percussion  note  which  is 
determined  by  its  density  and  its  relation  to  adjacent  struc- 
tures or  cavities  which  act  as  sounding  boards  or  resonance 
chambers.  Various  names  are  given  to  different  grades  and 
tones  of  the  percussion  note;  thus  we  speak  of  the  resonant 
note  of  the  normal  lung,  the  dull  note  of  the  liver,  the^a/  note 
of  abdominal  dropsy  or  the  tympanitic  note  of  the  stomach 
distended  with  gas.  The  methods  of  percussion  are  immedi- 
ate (direct),  or  mediate  (indirect),  in  the  former  of  which  light 
blows  with  the  fingers  or  small  mallet  are  delivered  directly 
on  or  over  the  tissue ;  in  the  latter  which  is  most  commonly 
used  a  pleximeter  is  interposed  between  the  structures  per- 
cussed and  the  fingers  or  mallet. 


108  PRINCIPLES   OF  OSTEOPATHY. 

By  auscultation  the  sense  of  hearing  enables  us  to  de- 
termine disordered  conditions  of  various  of  the  organs,  though 
by  this  method  the  sounds  produced  by  the  organs  in  their 
functioning  furnish  the  evidence.  A  change  from  the  usual 
nature  of  the  sounds  of  the  heart  is  indicative  of  cardiac  dis- 
order; the  respiratory  murmur  gives  evidence  of  a  normal  or 
abnormal  condition;  the  rumbling  sounds  produced  in  the  in- 
testines technically  spoken  of  as  borborygmus  suggests  over- 
active  fermentation;  or  the  friction  sounds  produced  by  the 
approximated  pleural  layers  denotes  the  dry  form  of  pleuritis. 

Mensuration  is  a  method  much  employed  by  osteo- 
paths not  so  much  perhaps  in  the  way  of  definite  tape-line 
measurement  which  is  often  helpful  and  occasionally  essential, 
but  by  comparison  in  size  and  shape  of  paired  or  symmetri- 
cal structures .  The  difference  in  size  between  the  sides  of 
the  chest  is  often  noticed ;  the  difference  in  the  width  of  the 
ilio-costal  spaces  is  valuable  in  numerous  cases;  the  shortening 
of  a  lower  limb  through  lesion  at  the  hip  or  pelvis  will  be 
noted  by  measurement  or  comparison ;  or  the  increased  cir- 
cumference of  the  shoulder  joint  will  be  diagnostic  of  a  dislocated 
shoulder. 

These  five  methods  modified  and  aided  by  pressure  and  rota- 
tion of  parts  will  either  singly  or  collectively  yield  sufficient 
data  to  indicate  the  essential  nature  of  most  of  the  disordered 
conditions  with  which  the  osteopath  meets.  All  of  them 
have  their  uses  and  their  special  value  and  the  osteopath  who 
entirely  neglects  any  will  certainly  find  occasion  to  regret  his 
inability  to  make  satisfactory  use  of  that  method. 

We  shall  not  further  discuss  the  question  of  symptoms  in 
the  diagnosis  of  special  diseases,  for  that  is  not  within  the 
province  of  this  work.  It  will,  however,  be  entirely  within 
the  province  to  take  up  for  discussion  the  diagnosis  of  lesions. 
A  consideration  of  this  question  is  distinctly  and  peculiarly 
osteopathic  since  it  is  only  the  osteopath  who  has  recognized 
the  existence  of  the  lesion,  at  least  in  the  special  use  of  that 
term  which  has  been  indicated  in  another  chapter. 


THE  DIAGNOSIS  OF  DISEASE.  109 

THE  DIAGNOSIS  OF  LESIONS. 

The  special  and  limited  meaning  of  lesion  is  an  osteo- 
pathic  creation  and  hence  it  will  be  necessary  to  go  quite 
into  detail  in  the  discussion  of  the  factors  entering  into  the 
determination  of  the  presence  of  a  lesion  in  any  specific  case. 
The  fact  has  been  emphasized  that  not  every  mal-position  of 
bony  or  other  structures  constitutes  a  lesion.  In  a  few  cases 
such  a  condition  may  be  the  only  evidence  of  lesion  and  still 
be  a  real  lesion  in  the  two-fold  idea  assigned  to  that  word, 
i.  e.,  structural  change  producing  functional  disorder,  but  in  the 
majority  of  cases  with  which  the  osteopath  deals  there  will  be 
other  evidences  which  substantiate  the  diagnosis.  Further, 
in  this  discussion  we  shall  not  take  up  in  detail  the  different 
forms  of  lesion  as  they  may  exist  separately — bony,  muscu- 
lar, ligamentous,  visceral — but  shall  limit  the  consideration 
to  a  typical  case  where  there  is  a  combination  of  the  first 
three  named.  For  it  cannot  be  too  strongly  emphasized  that 
in  most  conditions  of  skeletal  disorder  the  three  will  be  asso- 
ciated in  the  causation  of  the  functional  perversion.  In  the 
discussion  the  presence  of  such  an  association  is  assumed, 
and  the  points  essential  in  the  diagnosis  of  that  condition 
will  be  indicated.  There  are  two  fundamental  principles  to 
be  noted  in  the  method  of  making  an  examination  of  any 
part  of  the  body,  the  one  of  which  will  tend  to  prevent  pos- 
sible error  arising  from  the  other.  The  part  should  be  ex- 
amined in  its  functional  activity.  A  perverted  function 
will  be  manifest  in  the  appearance  of  the  action  of  the  organ 
which  performs  the  function.  In  torticollis  or  wryneck  the 
sterno-mastoid  muscle  presents  an  appearance  when  in  action 
entirely  different  from  that  while  at  rest.  Comparison  of  the 
muscle  in  the  horizontal  position  with  it  in  the  erect  position 
of  the  body  will  suggest  facts  that  otherwise  would  escape 
attention.  In  the  horizontal  posture  the  neck  muscles  will  be 
in  functional  rest.  In  the  examination  of  a  hip  the  action 
of  it  should  be  noted,  but  in  addition  the  position  of  its  vari- 


110  PRINCIPLES   OF  OSTEOPATHY. 

ous  parts  should  be  determined  by  palpation  during  its  rest. 
The  movement  of  the  chest  should  be  noted  and  compared 
with  that  of  a  normal  action,  in  addition  to  noting  the  posi- 
tion of  the  ribs  while  in  expiration  and  pause.  The  move- 
ment of  the  inferior  maxillary  may  suggest  the  nature  of  the 
lesion  more  markedly  than  will  an  examination  of  it  in  the 
quiet  state. 

Passing  to  the  details  in  diagnosis  it  will  be  noted  that 
the  first  evidence  that  a  lesion  exists  is  the  perversion  of 
function  of  some  organ  or  structure,  which  is  likely  to  be 
first  discerned  by  the  patient  or  some  one  other  than  the 
physician.  The  patient  gives  the  information  that  he  has 
functional  disorder  of  some  special  organ.  That  fact  indi- 
cates in  general  the  part  of  the  organism  where  lesion  is 
most  likely  to  be  found;  if  it  be  gastric  disturbance  the 
splanchnic  or  the  vagal  region  will  be  suspicioned;  if  a  uter- 
ine trouble,  the  lower  thoracic,  the  lumbar  or  sacral  struct- 
ures will  first  be  examined;  if  the  eye  be  impaired,  the  atlas 
and  the  upper  thoracic  is  more  likely  disturbed. 

The  general  attitude  is  a  factor  in  the  determination 
of  the  approximate  location  of  the  lesion.  Dr.  Still  has  em- 
phasized the  fact  that  the  position  that  a  patient  assumes  is  normal 
to  the  existing  structural  condition,  which  is  but  a  special  applica- 
tion of  the  doctrine  that  function  is  normal  to  structure.  To 
make  a  concrete  case,  suppose  a  lesion  of  considerable  mag- 
nitude exists  in  the  cervical  muscles  of  the  patient.  The  man- 
ner in  which  he  carries  the  head' suggests  a  cervical  lesion. 
If  a  rib  be  luxated  the  patient  will  sit  in  such  a  position  as 
will  secure  him  the  least  irritation.  The  careful  way  in 
which  an  individual  afflicted  with  Pott's  disease  carries  his 
body  immediately  suggests  a  spinal  lesion.  In  all  of  these 
cases  the  position  or  the  attitude  is  normal  to  the  lesion,  that 
is,  it  is  such  because  the  lesion  or  its  effects  compels  it  to  be 
such.  Hence  the  value,  when  a  patient  presents  himself  for 
examination,  of  making  a  preliminary  survey  of  the  individ- 
ual as  a  whole. 


THE   DIAGNOSIS   OF   DISEASE.  Ill 

The  position  of  landmarks  is  a  second  point  to  be  con- 
sidered. Having  determined  the  probable  region  of  the 
lesion  by  the  method  above  described,  a  peculiarity  in  the 
positional  relation  between  certain  parts  used  as  points  for 
comparison  may  be  noticed.  If  in  the  case  of  a  vertebra,  the 
relation  of  its  spinous  process  to  those  adjacent  may  be  al- 
tered ;  the  intercostal  space,  in  case  of  a  rib,  may  be  found  to 
vary  in  regularity  throughout  its  extent,  or  may  be  narrowed 
or  widened  in  comparison  with  those  above  or  below; 
the  lower  margin  of  the  liver,  in  a  lesion  condition  of  that 
organ,  will  be  displaced.  It  seems  necessary  to  emphasize 
the  fact  in  this  connection,  that  no  greater  mistake  can  be  or 
has  been  made  than  that  of  assuming  the  existence  of  a  lesion  when- 
ever it  is  found  that  there  is  a  variation  in  position  of  a  structure. 
Reference  has  been  made  to  the  fact  that  structure  as  well  as 
function  can  vary  from  the  average  within  wide  limits  and 
still  the  condition  be  a  normal  one.  While  it  is  convenient  to 
compare  the  body  to  a  machine  and  insist  that  in  both  cases 
a  variation  of  the  slightest  degree  in  structural  parts  will 
cause  disorder  in  the  one  as  in  the  other,  the  comparison  is 
not  illuminating  if  carried  to  extremes.  The  machine  is  an 
unyielding  structure  and  has  no  power  of  adjustment,  which 
makes  the  necessity  for  perfect  structural  alignment  an  ab- 
solute one.  The  living  machine,  on  the  other  hand,  is  made 
up  of  yielding  parts  and  has  immense  possibilities  of  adjust- 
ment to  an  abnormal  structural  change.  The  universal  ten- 
dency on  the  part  of  the  beginning  student  seems  to  be  to 
make  the  assumption,  unfortunate  as  that  fact  may  be.  In 
some  cases  it  would  seem  that  the  apparant  structural 
change  is,  of  all  the  several  evidences  of  lesion,  the  most 
unreliable. 

A  further  evidence  of  the  presence  of  the  lesion  is  the 
sensory  change.  While  this  usually  takes  the  form  of 
definite  pain,  in  many  cases  it  is  of  the  nature  of  such  pecul- 
iar sensations  as  anaesthesia,  hyperaesthesia,  or  paraes- 
thesia;  under  the  latter  term  is  included  the  burning  sensa- 


112  PRINCIPLES   OF   OSTEOPATHY. 

tions,  tightness  of  tissue,  or  of  formication,  i.  e.,  sensation  as 
of  a  small  insect  creeping  over  a  part.  Any  of  these  may  be 
present  either  at  the  local  area  of  the  lesion  or  may  be  re- 
motely situated  and  partake  of  the  nature  of  transferred 
sensation. 

Pain  is  of  such  importance  that  we  shall  enter  into  detail 
showing  its  relation  to  lesion  and  disease.  It  has  been  de- 
fined as  the  "prayer  of  a  nerve  for  pure  blood",  and  this 
conception  is  apt  in  many  cases.  It  is  a  sensation,  perceived 
by  the  cerebral  cells  concerned  with  consciousness,  produced 
by  an  irritation  of  some  form  to  a  sensory  nerve.  Without 
entering  into  the  argument  for  or  against  the  contention  that 
there  exist  special  pain  nerves  or  special  pain -receiving  end 
organs,  suffice  it  to  hazard  the  opinion  that  any  afferent 
nerve  if  sufficiently  irritated  will  give  the  sensation  of  pain. 
Note  the  fact  that  the  sensation  is  a  brain  sensation  though  it 
is  usually  projected  to  the  part  irritated.  For  instance  the 
sensation  from  a  burned  finger  is  felt  in  the  sensorium  but 
the  individual  is  entirely  aware  that  the  irritation  is  at  the 
finger.  With  reference  to  this  fact,  note  the  want  of  logic  in 
the  reasoning  of  the  individual  who  is  content  with  giving  a 
drug  which  renders  the  sensorium  less  capable  of  receiving 
or  responding  to  the  transmitted  impulse.  The  pain  is  still 
present  in  so  far  as  the  nerve  disturbance  constitutes  the 
pain.  The  drug  has  simply  rendered  the  patient  unaware  of 
the  existence  of  irritation.  Pain,  then,  is  a  distinct  advan- 
tage to  the  organism,  and  it  is  in  relation  to  its  advantage  in 
the  way  of  assistance  in  the  diagnosis  of  the  lesion  that  it 
will  further  be  discussed. 

It  is  to  be  noted  that  pain  may  be  direct  as  when  caused 
by  irritation  produced  directly  upon  the  part  to  which  the 
sensation  is  referred.  For  instance,  an  irritant  taken  into  the 
stomach  may  cause  the  sensation  referred  to  that  region ;  or 
the  pressure  upon  the  ulnar  nerve  causes  pain  at  the  point  of 
pressure;  a  contractured  muscle — e.  g.,  the  pyriformis — may 
irritate  directly  the  sciatic  nerve  and  the  whole  nerve  will 


THE   DIAGNOSIS   OF   DISEASE. 


113 


suffer.  In  this  case  the  pain  is  felt  not  only  at  the  point  of 
pressure  but  throughout  the  entire  neuron ;  for  note  that  in  the 
pressure  on  the  ulnar,  while  the  pain  may  be  felt  at  the  pres- 
sure, it  will  likely  be  more  noticed  in  the  finger,  i.  e.,  at  the 
peripheral  end  organs.  In  this  case  it  is  not  necessarily 
simply  a  reference  by  consciousness,  but  an  actual  disturb- 
ance of  molecular  vibration  throughout  the  entire  nerve  ele- 
ment, with  a  consequent  arousing  of  impulses  from  all  parts 
suffering  the  disturbed  vibration,  and  the  greatest  intensity 
of  impulse  will  come  from  those  parts  which  are  especially 
developed  for  the  purpose,  i.  e.,  the  sensory  endings  in  the 
periphery.  But  the  pain  may  be  indirect  or  referred.  In 
this  case  a  peculiar  fact  is  to  be  noted,  a  fact  that  has  been 
put  in  definite  formulation  by  Head  and  which  is  spoken  of  as 
Head's  Law.  This  law  states  that,  "  When  a  painful  stimulus  is 
•applied  to  apart  of  low  sensibility  in  close  central  connection  with  a 

part  of  much  greater  sensibility,  the  pain 
produced  is  felt  in  the  part  of  higher 
sensibility  rather  than  in  the  part  of  lower 
sensibility  to  which  the  stimulus  was 
actually  applied."  While  this  is  a 
fairly  correct  statement  of  the  real 
condition  it  should  not  be  dignified 
by  the  name  of  "law,"  since  in  the 
above  wording  it  cannot  apply  to  all 
cases  by  any  means.  Head  based 
the  law  on  observations  with  especial 
reference  to  visceral  versus  spinal 
pain.  It  is  known  that  many  of  the 
viscera  are  comparatively  insentient 

Fig.  T.-Illustratlng  mechanism  .     ' 

in  referred  pain.  under  ordinary  conditions.    That  is, 

the  nerves  capable  of  conducting  an  impulse  producing  the 
sensation  of  pain  are  comparatively  few  and  inefficient,  and 
hence  the  irritation  sufficient  to  give  pain  must  be  corres- 
pondingly intense.  But  every  one  is  aware  that  pain  may  be 
produced  in  a  viscus,  and  in  order  to  show  that  Head's 


114  PRINCIPLES   OF  OSTEOPATHY. 

law  holds,  it  must  be  proven  that  the  part  of  higher 
sensibility  is  the  part  most  noticed  by  consciousness  on  the 
application  of  the  stimulus  to  the  more  insentient  organ. 
That  such  is  the  case  in  numerous  instances  may  readily  be 
admitted  but  that  it  is  true  in  all  is  disproved.  Were  it  stated 
that  the  pain  may  be  felt  in  the  part  of  higher  sensibility  the 
objection  to  the  statement  would  cease.  Ii)  this  latter  inter- 
pretation the  question  will  be  considered.  Note  that  the  law 
provides  for  a  condition  where  there  is  a  "close  central  connec- 
tion." It  is  to  be  remembered  that  though  little  evidence  of 
an  anatomical  nature  can  be  adduced,  there  is  much  from 
physiological  and  embryological  investigation  to  show  that 
the  spinal  cord  and  less  noticeably  the  brain  are  segmental 
structures.  We  may  arbitrarily  divide  the  cord  into  seg- 
ments corresponding  with  the  paired  arrangement  of  the 
spinal  nerves  and  assume  with  little  possibility  of  error  that 
this  division  represents  a  physiological  segmentation.  Each 
part  of  a  segment  acts  more  with  reference  to  its  other  parts 
than  with  parts  from  an  adjacent  segment  is  a  statement  that 
is  true  in  general.  Hence,  two  nerve  fibres  having  their  cen- 
tral endings  in  the  same  segment  will  be  in  more  intimate  re- 
lation than  fibres  from  different  segments.  This  fact  is  in- 
dicated from  various  evidences  derived  from  experiment,  es- 
pecially in  reference  to  reflex  action.  For  instance  Pfluger 
has  shown  that  a  stimulus  applied  to  a  limb  of  a  "spinal  frog'* 
produces  its  first  response  in  motion  of  that  limb,  but  the  next 
effect,  produced  by  a  stronger  stimulus  will  be  upon  the  limb 
of  the  opposite  side,  showing  the  radiation  of  the  impulse  to 
parts  in  the  same  segment.  An  additional  stimulus  will  cause 
effect  on  nerves  from  the  immediately  adjacent  segments.  But 
according  to  Head  and  others  who  have  investigated  the  same 
problem,  the  phenomenon  is  not  limited  to  a  reflex  mechanism 
such  as  is  present  in  the  above  cases.  A  sensory  nerve  in 
connection  with  the  same  segment  may  be  involved,  or  at 
least  the  pain  may  be  referred  to  the  area  of  distribution  of 
that  sensory  nerve.  Head  calls  attention  to  the  fact  that  with 


THE   DIAGNOSIS   OF  DISEASE.  115 

a  few  possible  exceptions,  each  viscus  is  related  in  this  way 
to  a  definite  area  of  cutaneous  tissue.  For  instance,  irrita- 
tion of  the  stomach  is  likely  to  be  associated  with  pain  in  the 
skin  areas  supplied  by  afferent  fibres  from  the  sixth,  seventh, 
eighth  and  ninth  thoracic  nerves.  It  is  significant  that  the 
pain  is  not  necessarily  of  a  .simple  "referred"  or  "trans- 
ferred" character.  It  is  noted  that  in  numerous  cases  there 
will  not  only  be  a  referred  pain,  but  what  is  a  different  thing, 
referred  tenderness,  in  which  case  it  is  suggestive  of 
distinct  nerve  disturbance  rather  than  a  reference  on  the  part 
of  consciousness.  But  the  reference  of  pain  is  not  necessar- 
ily from  a  diseased  viscus.  Osteopaths  continually  have  this 
fact  called  to  their  attentionjby  numerous  cases.  Hip  trouble 
gives  rise  to  pain  in  the  knee.  This  may  be  due  to  direct 
pressure  by  the  luxated  structures  upon  the  nerve  supplying 
the  articulation,  or  it  may  be  due  to  impingement  upon  the 
terminals  of  branches  distributed  to  the  hip  joint,  referred 
back  to  the  segment,  and  thence  out  over  the  branch  to 
the  knee.  For  we  know  that  the  same  nerve  trunks  which 
supply  the  articular  structures  of  the  hip  also  supply  those  of 
the  knee.  Similarly  Hilton  calls  attention  to  the  fact  that  the 
same  nerve  trunk  that  supplies  a  joint,  also  supplies  the  skin  which 
overlies  it  and  the  muscles  that  move  it,  and  a  further  usual  circum- 
stance of  interest,  th&tthebowel  wall,  the  peritoneal  structures  asso- 
ciated with  it,  and  the  skin  overlying  these,  are  all  supplied  from 
the  same  segmental  source.  Attention  is  further  called  to  the 
fact  that  ear-ache  may  be  associated  with  disturbances  in  the 
nutrition  of  the  teeth,  both  of  these  structures  being  supplied 
by  the  fifth  cranial.  In  all  of  these  cases  we  have  a  principle 
that  is  similar  if  not  identical.  Further  facts  suggested 
by  Hilton  in  relation  to  referred  pain  may  be  of  some  value. 
He  notes  first  that  pain  in  the  cutaneous  structure  not  associ- 
ated with  a  high  temperature  of  the  part  is  suggestive  of  a  distant 
origin  of  the  pain,  and  usually  that  origin  is  in  the  spine. 
He  instances  in  this  connection  what  osteopaths  have  been 
able  to  corroborate  in  many  cases,  that  a  sensory  disturbance 


116  PRINCIPLES   OF   OSTEOPATHY. 

in  the  anterior  terminals  of  the  thoracic  spinal  nerves  is  often 
due  to  a  spinal  lesion,  no  local  disorder  being  manifest.  A 
further  rule  is  that  when  the  pain  is  symmetrical  it  is  almost 
certainly  caused  by  a  central,  i.  e.,  spinal  disorder.  The  ap- 
plication of  the  foregoing  facts  is  apparent.  By  means  of 
the  pain  or  tenderness  we  may  trace  the  situation  of  the  seg- 
ment of  the  cord  which  is  involved.  That  involvement  maybe 
or  may  not  be  dependent  on  a  lesion  at  the  corresponding 
vertebra,  but  in  the  vast  majority  of  cases  such  a  lesion  will 
be  found.  Even  though  the  definite  structural  change  be 
absent  from  this  part,  the  organ  involved  will  be  indicated 
and  indirect  aid  be  given  in  the  diagnosis. 

The  tender  spots,  for  the  discovery  of  which  the  osteo- 
path is  famous,  are  always  significant.  In  most  cases  these 
points  of  increased  sensitiveness  are  quite  limited  in  extent  and 
suggest  in  most  cases  not  a  referred  but  a  direct  condition  of 
irritation.  For  instance  in  the  examination  for  a  lesion  of 
the  spine,  just  at  the  region  between  the  spinous  and  trans- 
verse processes  the  tissues  are  tender  on  pressure.  This  is 
always  suggestive  of  local  disturbance,  i.  e.,  congestion,  in- 
flammation, or  contracture  of  tissues  sufficient  to  irritate  the 
sensory  nerve  terminals  in  the  part.  In  palpation  for  such 
tender  areas  care  must  always  be  exercised  or  a  tender  spot 
may  be  produced  where  none  before  existed.  Bear  in  mind 
that  sufficient  pressure  in  any  part,  whether  normal  or  ab- 
normal, will  produce  pain  or  some  other  sensory  change. 
The  sensory  condition  of  the  part  under  examination  must 
always  be  compared  with  similar  adjacent  areas,  and  with  the 
average  condition.  This  last  must  be  a  question  of  expe- 
rience,— the  average  normal  condition  must  be  learned  before 
there  can  be  much  possibility  of  detecting  slight  changes — a 
statement  true  not  only  with  reference  to  pain,  but  to  all  of 
the  several  factors  enumerated. 

Emphasis  has  been  laid  upon  the  subject  of  pain  as  evi- 
dence of  lesion,  not  only  because  of  the  complexity  of  the 
subject,  but  because  of  its  primary  value  as  a  first  evidence 


THE   DIAGNOSIS   OF  DISEASE.  117 

of  disorder.  Of  the  numerous  changes  that  may  be  associ- 
ated with  a  lesion,  the  sensory  one  of  local  tender  areas  is 
among  the  most  important  and  least  associated  with  a  possi- 
bility of  error. 

Another  valuable  factor  in  determination  of  the  presence 
of  a  lesion  is  the  condition  of  the  associated  muscle  tis- 
sue. This  is  usually  spoken  of  as  a  contracture,  the  causes 
of  which  have  been  referred  to  in  the  section  on  causes  of  le- 
sions. It  becomes  necessary  to  distinguish  between  the 
meaning  of  contraction  and  contracture  in  order  that  confu- 
sion may  not  arise.  The  term  contraction  refers  to  the  state 
of  a  muscle  in  the  physiological  process  or  condition  of  short- 
ening and  thickening  of  the  muscle  not  associated  with  appre- 
ciable change  otherwise.  The  term  contracture,  on  the  other 
hand,  has  by  usage  become  involved  with  the  idea  of  a  path- 
ological condition  in  which  the  contraction  is  not  identical 
with  the  normal  state,  and  though  it  is  contracted  it  has  in 
addition  certain  other  characteristics.  True  enough,  a  con- 
traction long  continued  will  usually  result  in  a  fairly  typical 
contracture  but  that  the  ordinary  contractured  muscle  with 
which  the  osteopath  is  so  familiar  is  not  identical  with  a  pro- 
longed contraction  will  hardly  be  denied  by  any  one  who  has 
carefully  compared  the  two.  Physiologists  recognize  that 
there  exist  conditions  of  change  of  shape  in  muscle  not  sim- 
ilar to  the  usual  contraction,  and  to  which  have  been  given 
the  name  of  idiomuscular  contraction.  Specific  instances  of 
such  are  noticed  in  case  of  fatigued  muscles,  which  on  the 
application  of  a  stimulus — e.  g.,  a  mechanical  blow — responds 
not  by  a  wave  of  contraction  passing  to  all  parts  of  the  muscle, 
but  by  a  local  swelling  of  the  tissue  to  which  the  stimulus  was 
applied.  This  change  persists  for  some  considerable  time  after 
the  withdrawal  of  the  stimulus  and  in  this  respect,  therefore, 
also  differs  from  a  normal  contraction.  If  the  actual  condi- 
tion of  the  muscle  could  be  accurately  analyzed,  it  would 
likely  be  found  that  the  contracture  with  which  the  osteopath 
is  peculiarly  acquainted  and  the  idiomuscular  contraction 


118  PRINCIPLES   OF   OSTEOPATHY. 

referred  to  by  the  physiologist,  would  more  nearly  be  identi- 
cal than  would  the  former  with  normal  physiological  contrac- 
tion. If  a  muscle  is  contractured  it  presents  certain  peculiar 
characteristics  to  the  examiner.  In  the  first  place  it  will  give 
evidence  of  a  shortening  and  thickening,  in  which  statement 
nothing  is  indicated  showing  any  difference  from  the  ordi- 
nary contraction.  But  in  reality  if  care  be  exercised  in  pal- 
pation a  distinct  difference  will  be  noted.  Instead  of  a 
homogeneity  of  the  contraction  there  will  be  an  irregularity, 
some  of  the  fibres  apparently  in  a  normal  tonic  condition, 
while  others  are  distinctly  knotted.  A  further  noticeable  fact 
will  be  the  peculiar  "ropy"  feeling  as  the  fingers  are  passed 
over  the  muscle  at  right  angles  to  the  course  of  the  fibers.  In 
other  cases  the  term  "welted"  would  be  more  descrip- 
tive. A  further  characteristic  of  the  tissue  is  a  peculiarity 
in  the  denseness, — a  sensation  transmitted  to  the  fingers  diffi- 
cult of  description,  and  due  in  all  likelihood  to  a  change  in 
the  nature,  amount,  and  disposition  of  the  various  fluid  ma- 
terials associated  with  the  muscle,  i.e.,  the  blood,  lymph,  and 
muscle  plasma.  Another  condition  of  the  contractured  tissue 
is  the  sensory  change  noted  in  it  and  to  which  sufficient  refer- 
ence has  been  made.  Emphasis  should  be  laid  upon  the  fact 
that  a  persistent  contraction  or  contracture  will  invariably 
result  in  a  sensory  disorder  of  some  kind.  Finally,  material 
aid  may  be  given  in  the  determination  between  a  muscle 
physiologically  contracted  and  one  in  contracture  by  caus- 
ing the  individual  or  part  to  assume  a  position  in  which  the  ne- 
cessity for  physiological  contraction  ceases  to  exist.  For  instance 
so  long  as  the  individual  is  in  the  sitting  posture  the  deep 
cervical  muscles  will  be  functionally  active.  On  assuming 
the  horizontal  position  the  necessity  for  their  contraction 
ceases  to  exist  and  they  will  normally  relax.  If,  however, 
the  muscles  be  contractured,  the  relaxation  on  changing  posi- 
tion will  not  be  so  apparent.  Note  that  it  is  a  condition  of 
degree,  for  the  abnormal  muscle  will  undergo  partial  relaxa- 
tion when  its  contraction  is  no  longer  needed. 


THE  DIAGNOSIS   OP   DISEASE.  119 

The  degree  of  amplitude  of  movement  is  a  factor  of 
much  value  in  diagnosis  of  the  lesion,  and  one  which  is  close- 
ly associated  with  the  condition  of  all  the  structures.  We 
have  noted  that  in  most  typical  lesion  conditions,  bony,  liga- 
mentous,  and  muscular  changes  are  associated  and  interde- 
pendent. All  three  are  concerned  in  producing  the  change 
in  the  freedom  with  which  the  part  moves.  A  bony 
luxation  usually  will  lessen  the  extent  of  movement,  and  so 
will  ligamentous  strain  and  muscle  contracture.  On  the 
other  hand  a  lax  ligamentous  and  muscular  condition  will 
permit  of  excessive  rotation.  The  condition  of  the  spine 
spoken  of  as  a  "rigid",  or  "smooth"  spinal  column  (Haz- 
zard)  is  a  case  in  point.  The  rigidity  may  be  due  to  "locked" 
vertebrce — rare — thickened  and  hardened  connective  structures, 
'deposits  in  or  absorption  of  intevertebral  and  articular  carti- 
lages as  in  articular  rheumatism,  or  to  simple  but  general 
muscle  contracture,  in  the  latter  case  usually  yielding  on  appli- 
cation of  measures  designed  to  relax  the  muscles.  Bony 
anhylosis  is  a  condition  occasionally  met  with  and  will  mani- 
fest itself  by  absolute  immobility. 

Temperature  changes  in  the  local  part  are  often 
found  and  usually  are  indicative  of  local  lesion.  The  exist- 
ence of  a  lesion  means  local  irritation.  Irritation  calls  for  or  at 
least  results  in  hyperaemia,  and  hyperaemia  may  pass  into  in- 
flammation. In  either  of  the  last  two  conditions  there  will  be 
increased  heat  because  of  increased  blood,  the  latter  being 
the  principal  medium  by  which  heat  is  distributed.  But  the 
increased  temperature  may  be  locally  produced.  Especially 
is  this  likely  where  local  inflammation  is  present,  the  increased 
metabolic  changes  being  responsible  for  an  increased  oxida- 
tion with  liberation  of  heat.  Attention  is  often  called  to  a  rib 
lesion  through  the  difference  in  temperature  along  the  course 
of  the  rib  as  compared  to  that  above  or  below.  It  is  not  neces- 
sarily an  increase,  but  may  be  a  decreased  temperarure  that 
is  noticed.  A  cold  state  of  the  posterior  cervical  structures  is  a 
common  accompaniment  of  the  lesion  in  that  region.  Dr. 


120  PRINCIPLES   OF   OSTEOPATHY. 

Still  calls  attention  to  the  lowered  temperature  of  the  skin  in 
the  gluteal  and  lower  spinal  regions  in  case  of  croup,  while  the 
ventral  structures  may  show  an  increased  temperature.  The 
numerous  cases  noted  and  the  equally  numerous  possible 
causes  of  changed  temperature  suggest  the  importance  of  a 
careful  training  of  the  fingers  in  the  temperature  sense. 

Finally,  the  color  of  the  part  under  suspicion  may  be  an 
indication  of  a  lesion.  In  most  cases  the  difference  in  color 
will  be  dependent  on  the  amount  of  blood  present,  congestion 
causing  redness,  ischaemia  producing  pallor.  Pigmentary 
deposits  may  occasionally  be  noted  in  the  region  of  a  lesion, 
from  the  blood  or  other  change  associated. 

In  all  the  examination  for  the  nature  and  location  of  a 
lesion  the  several  factors  mentioned  should  be  borne  in  mind. 
In  the  vast  majority  of  cases  only  a  few  of  them  will  be  ap- 
preciably present.  The  greater  the  number  the  more  certain 
the  diagnosis.  The  absence  of  one  or  all  does  not  disprove  the 
presence  of  a  real  lesion  and  a  serious  one,  but  renders  its  pres- 
ence much  less  likely.  Note  the  fact  that  numerous  osteo- 
paths are  quoted  in  the  expression  "There  was  no  lesion  in 
the  case."  The  want  of  logic  evidenced  by  such  assertion  is 
quite  apparent.  It  is  not  necessary  in  order  that  there  be  a 
real  lesion  that  the  condition  can  be  determined  with  the  eyes 
closed  and  gloves  on  the  hands.  To  assume  that  every  lesion 
can  be  detected  is  to  assume  the  impassible.  Lesions  may  be 
microscopic  and  still  be  lesions  as  judged  by  our  definition, 
and  he  twho  thinks  it  necessary,  in  the  case  of  impreceptible 
lesion,  to  assume  the  existence  of  some  other  cause  for  the 
disorder  than  that  of  the  lesion,  or  that  the  manipulation  of 
a  part  which  produced  a  cure  of  this  disorder  did  so  other 
than  by  removal  of  lesion,  is  making  use  of  extremely  faulty 
logic. 


THE   TREATMENT  OF   DISEASE.  121 


CHAPTER  VII 


THE  TREATMENT  OF  DISEASE. 
PROPHYLAXIS  AND  THERAPEUTICS. 

The  ultimate  end  which  we  have  in  view  in  the  determin- 
ation of  the  etiology  and  diagnosis  of  disease  is  but  to  pre- 
pare a  rational  basis  for  the  treatment  of  disease.  By  the 
treatment  of  disease  is  meant  any  method  or  measzire  which  wilt 
assist  the  organism  in  re-establishing  its  normal  function.  More 
appropriately,  it  is  the  treatment  of  the  diseased  organism 
rather  than  the  treatment  of  disease,  for  the  disease  will  be- 
disposed  of  by  the  organism  itself  if  freedom  is  given  to  th& 
healing  agencies  inherent  in  the  organism.  Broadly  speak- 
ing there  are  two  grand  divisions  comprehended  in  the  word 
treatment,  one  of  which  is  concerned  with  all  of  those  meas- 
ures designed  to  prevent  the  onset  of  disturbed  functioning-. 
Technically  this  is  spoken  of  as  prophylaxis. 

The  term  prophylaxis  is  a  comprehensive  one  and  has 
rather  indefinite  limits.  In  the  first  place  it  is  concerned  with 
the  conditions  of  the  environment  of  the  individual.  Sanitary 
measures  employed  by  a  municipality,  including  regulations 
governing  sewerage  systems,  tenement  house  requirements, 
and  the  like,constitute  definite  prophylactic  treatment  applied 
collectively.  Hygiene  in  the  nature  of  cleanliness,  normal 
exercise  and  the  breathing  of  pure  air  or  the  eating  of  proper 
food  in  proper  amounts,  constitutes  prophylaxis  of  the  indi- 
vidual with  regard  to  his  environment.  On  the  other  hand 
prophylaxis  is  applied  directly  to  the  organism  itself  either  by 
the  removal  of  the  predisposing  cause,  as  for  instance  the  in- 
creasing of  the  chest  capacity  by  lifting  and  adjusting  the 
ribs  in  order  to  avoid  furnishing  suitable  soil  for  the  propa- 
gation of  the  tubercle  baccillus;  overcoming  the  irritable 
mucous  membrane  of  the  nasal  passages  to  prevent  an  at- 

9 


122  PRINCIPLES   OF   OSTEOPATHY. 

tack  of  hay  fever  brought  on  by  the  presence  of  dust  particles 
in  the  air;  or  insistence  on  abstaining  from  further  abuse 
of  an  organ  which  otherwise  would  ultimately  result  in  ex- 
haustion and  hence  disease,  for  example,  where  there  is  a 
tendency  to  writer's  cramp;  or  prophylaxis  is  applied  in  the 
avoidance  of  the  exciting  cause,  or  the  direct  destruction  of  that 
exciting  cause.  As  illustration  of  this  second  method,  the 
patient  may  be  directed  to  remove  to  a  climate  more  favora- 
ble to  his  health,  as  in  the  case  of  the  hay  fever  victim  who 
passes  his  summers  in  an  atmosphere  less  laden  with  irritat- 
ing particles ;  or  the  use  of  antiseptic  washes  in  the  case  of 
contagious  diseases. 

But  measures  may  be  applied  in  the  treatment  of  the  or- 
ganism after  the  disease  is  present,  and  this  constitutes  what 
is  technically  spoken  of  as  therapeutics.  It  is  necessary 
to  observe  as  a  precaution  that  many  writers  make  use  of  this 
term  to  embrace  both  preventive  and  curative  treatment.  As 
a  matter  of  convenience  the  two  terms  should  be  kept  within 
their  proper  limitations.  In  the  application  of  therapeutic 
treatment  one  or  both  of  two  policies  may  be  pursued,  the  re- 
moval of  the  lesion  condition  or  the  abstinence  from  any  use 
of  the  organ  that  under  the  circumstances  would  constitute 
an  abuse.  In  the  case  of  an  individual  afflicted  with  stomach 
trouble  dependent  upon  a  splanchnic  lesion  the  proper  treat- 
ment for  such  disorder  would  consist  in  the  removal  of  the 
specific  lesion.  So  long  as  the  lesion  exists  some  care  may 
be  necessary  to  avoid  any  overwork  or  other  abuse  of  that 
organ.  If  on  the  other  hand  the  primary  cause  of  the  gastric 
unrest  is  abuse  by  errors  in  diet,  therapeutics  would  consist — 
granting  there  were  no  lesion  present — in  the  regulation  of 
the  dietetic  habits  of  the  patient. 

Of  the  two  ideas  associated  with  treatment,  that  of  pro- 
phylaxis occupies  the  higher  plane,  for  prevention  is  al- 
ways better  than  cure  though  not  necessarily  in  the  ratio  of 
the  ounce  to  the  pound.  It  is  the  dream  of  the  idealist  that  a 
time  may  sometime  come  when  there  will  be  a  greater  de- 


THE  TREATMENT   OF  DISEASE.  123 

mand  on  the  part  of  the  people  for  prophylactic  than  for 
therapeutic  treatment;  when  individuals  will  pay  greater  at* 
tention  to  laws  of  health  and  will  go  at  frequent  intervals  to 
a  qualified  physician  for  the  purpose  of  physical  examination 
to  detect  any  predisposing  lesions  that  may  have  arisen  since 
the  last  examination  or  treatment.  But  the  dream  of  the 
idealist  will  hardly  be  realized  in  this  generation  and  hence 
comparatively  little  prophylaxis  of  that  nature  will  be  used. 
The  average  osteopath  will  only  be  called  upon  to  treat  a 
case  after  the  evidence  of  disorder  is  markedly  present. 
Hence  relatively  greater  stress  must  at  present  be  laid  upon 
the  therapeutic  side,  except  in  that  the  physcian  may  make 
himself  a  distinct  force  for  the  dissemination  of  knowledge 
regarding  the  body  and  the  laws  of  its  health,  together  with 
a  hearty  co-operation  with  all  legitimate  efforts  to  enforce 
sanitary  measures  applied  collectively  to  a  city  or  commun- 
ity. 

The  relation  that  the  removal  of  lesion  bears  to  prophy- 
laxis, even  in  case  of  a  therapeutic  treatment,  we  have  dis- 
cussed in  a  former  article  ("The  Ounce  of  Prevention",  Nov. 
1902  issue  of  the  Journal  of  Osteopathy^  a  part  of  which  is 
reproduced  in  this  connection :  "But  after  all  that  may  be 
said  of  the  curative  treatment,  is  not  every  osteopathic  treat- 
ment a  prophylactic  one?  The  use  of  the  term  curative  is 
essentially  incorrect.  The.  physician  does  not  cure.  "We  ob- 
ject to  the  definition  of  osteopathy  which  affirms  that  the 
physician  "directs"  the  inherent  recuperative  forces  of  the 
body.  The  direction  of  those  forces  abides  in  a  higher  and 
more  subtle  power  than  can  be  exercised  by  the  hand  of  an- 
other individual  even  though  it  may  be  guided  by  a  high 
order  of  intelligence.  Neither  does  he"regulate  functioning", 
except  in  a  very  secondary  sense;  and  herein  lies  one  weak- 
ness in  the  philosophy  of  the  "vital  lesion"  osteopath. 
Functions  are  controlled  by  an  inherent  force  which  we  de- 
nominate "vital".  That  force  itself  cannot  go  permanently 
wrong.  It  will  not  cause  permanent  disorder  of  structure 


124  PRINCIPLES   OF  OSTEOPATHY. 

except  it  be  hindered  by  blocked  channels  of  interchange. 
And  herein  also  lies  the  fallacy  of  the  Christian  Scientist  and 
all  other  mental  healers.  The  "tendency  to  the  normal" 
operates  in  psychic  as  well  as  in  material  substance,  and  the 
normal  in  mind  and  emotion  will  be  assumed  if  the  organiza- 
tion of  cell  life  be  intact.  If  then  the  physician  does  not  reg- 
ulate functions  or  direct  forces,  what  does  he  do?  Funda- 
mentally, he  clears  the  way.  Does  that  cure?  The  disease 
as  it  existed  before  the  lesion  was  removed  was  caused  by 
perverted  function  resulting  from  the  lesion.  On  the  removal 
of  the  lesion  the  disease  as  it  exists  will  be  overcome  by  the 
restored  normal  functioning.  The  physician  in  removing  the 
lesion  has  prevented  the  further  progress  of  the  disease.  He 
has  applied  preventive  treatment." 

"Is  it  the  assertion  of  an  extremist  to  say  further  that 
even  in  the  removal  of  a  lesion  the  physician  is  not  overcoming 
a  structural  condition?  In  the  vast  majority  of  cases  with 
which  the  osteopath  meets,  the  treatment  does  not  consist  in 
"setting"  a  bone,  if  we  use  the  term  in  the  sense  in  which  it 
is  commonly  used.  In  a  case  of  a  recently  luxated  hip  the 
osteopath  may  be  successful  in  one  treatment.  In  such  a 
case  he  perhaps  is  not  simply  aiding  nature.  But  in  the 
countless  other  lesions  met  with,  chronic  changes  are  present 
which  do  not  admit  of  immediate  replacement.  In  such  cases 
the  prime  importance  of  the  physician  is  as  an  assistant  to 
the  organism.  When  a  lesion  is  produced  by  whatever  cause 
one  of  several  things  takes  place.  Nature  first  attempts  to 
overcome  the  structural  disturbance  and  is  usually  successful. 
Every  football  player  and  every  one  who  has  watched  the 
game  will  readily  believe  that  numerous  structural  condi- 
tions are  produced  during  the  strenuous  periods.  Do  every 
one  of  these  need  a  treatment?  Hardly.  Tension  of  tissue 
supplies  sufficient  treatment.  But  occasionally  a  structural 
disorder  is  sufficient  in  degree  to  pass  the  limits  of  self -ad- 
justment. Failing  in  drawing  the  part  back  to  normal  the 
tissues  on  one  side  gradually  yield,  on  the  other  gradually 


THE  TREATMENT   OF  DISEASE.  125 

shorten,  and  with  other  changes  a  partial  adjustment  to  the 
new  circumstances  takes  place.  What  must  the  osteopath 
do?  In  the  case  where  nature  is  still  making  the  attempt  to 
re* align,  he  can  assist  by  releasing  the  hindering  structures 
and  in  the  average  case  "nature  will  do  the  rest."  In  this 
case  he  is  not  curing,  he  is  preventing.  "Where  complete  ad- 
justment to  the  changed  condition  has  taken  place  he  is  per- 
haps more  surely  applying  a  curative  measure  in  the  break- 
ing up  of  adhesions  and  stretching  permanently  shortened 
muscles  and  ligaments." 

"Hence  after  all  we  are  using  the  ounce  rather  than  the 
pound,  though  for  various  reasons  some  of  which  are  indi- 
cated above,  we  are  rather  late  in  making  the  application. 
But  time  will  remedy  the  difficulty  to  a  large  extent,  and  then 
we  shall  be  able  not  only  to  prevent  the  progress  but  also  the 
beginning  of  the  pathological  condition." 

CURATIVE  VERSUS  PALLIATIVE  TREATMENT. 

A  further  classification  of  treatment  is  made  having 
reference  to  the  immediate  purpose  and  effect,  as  to  whether 
it  be  curative  by  virtue  of  aiding  in  the  removal  of  the  cause 
of  disease,  or  whether  it  be  palliative,  in  which  case  it  is  di- 
rected to  a  symptom  rather  than  a  cause.  If  the  physician 
overcomes  or  assists  the  organism  in  overcoming  a  lesion  of 
the  spine  which  is  causing  heart  disorder,  or  if  the  patient 
himself  abstains  from  the  abuse  of  his  heart  by  over  exercise 
where  such  has  been  the  cause,  a  curative  treatment  has  been 
applied.  If  on  the  other  hand  he  exerts  pressure  in  the  up- 
per thoracic  region  and  relieves  a  temporary  palpitation  or 
sensory  distress,  a  palliative  treatment  has  been  employed. 
No  definite  dividing  line  can  often  be  made  between  the  two, 
for  a  curative  treatment  will  in  a  large  number  of  cases  be 
palliative  also.  The  adjusting  of  the  ribs  by  the  treatment 
in  the  thoracic  region  thereby  taking  off  the  pressure  will 
give  relief  to  the  distressed  cardiac  structures.  On  the  other 
hand  in  numerous  cases  a  palliative  treatment  while  given 


126  PRINCIPLES  OF   OSTEOPATHY. 

explicitly  for  the  purpose  of  temporarily  overcoming  a  symp- 
tom may  in  the  long  run  be  curative  as  well.  A  treatment 
applied  for  the  purpose  of  lessening  the  intensity  of  pain  will 
in  occasional  cases  give  to  the  organism  a  better  opportunity 
for  repair,  which  was  wanting  so  long  as  the  nerve  dis- 
turbance continued.  Further,  it  may  become  necessary  that 
a  palliative  treatment  be  given  in  order  that  the  primary  cause 
may  be  reached.  For  instance,  an  obstruction  to  the  bowel 
from  impaction  may  cause  such  a  tension  of  the  abdominal 
wall  as  to  make  impossible  any  direct  manipulation  of  the 
impacted  area.  In  such  a  case  treatment  would  be  given  for 
the  purpose  of  relaxing  the  abdominal  muscles  which  would 
be  preparatory  to  the  primary  or  curative  treatment.  Or  in 
the  case  of  a  wrenched  spine  the  resulting  congestion  and 
contracture  of  the  superficial  spinal  muscles  may  be  such  as 
to  hinder  treatment  to  the  deeper  structures,  making  it  ad- 
visable if  not  essential  to  quiet  the  sensory  disturbance  and 
overcome  the  contractured  condition  before  attempting  the 
deeper  work.  Again,  a  palliative  treatment  may  be  essen- 
tial as  a  preliminary  to  further  diagnosis.  In  appendicitis  the 
bowel  wall  is  so  irritable  and  tense  as  to  prohibit  palpation 
deep  enough  to  determine  the  condition  of  the  caecum  and 
appendix;  or  the  superficial  cervical  tissues  may  be  so  con- 
tractured as  to  prevent  the  detection  of  a  deep  cervical  lesion. 
In  both  of  these  cases  the  palliative  or  temporary  treatment 
will  be  necessary  before  a  satisfactory  diagnosis  is  possible. 

ADJUSTMENT  OF  THE  OSSEOUS  LESION. 

The  statement  has  been  made  that  the  three  common 
forms  of  lesion,  bony,  muscular  and  ligamentous,  were  usu- 
ally associated  in  the  production  of  the  same  disorder.  In  the 
treatment  of  the  condition  a  movement  which  will  affect  one  will 
affect  the  others.  In  the  case  of  the  bony  and  the  muscular 
lesion  at  least,  special  and  peculiar  methods  must  be  used.  The 
ligamentous  lesion  will  be  affected  only  by  work  upon  the 
others.  Since  we  do  find  bony  and  muscular  lesions  associ- 


THE  TREATMENT   OF  DISEASE.  127 

ated  the  question  arises  as  to  which  should  have  precedence 
in  point  of  time.  It  must  be  confessed  that  there  is  a  differ- 
ence of  opinion  regarding  the  matter.  If  the  bony  disorder  is 
secondary  to  the  muscular  tension  and  is  maintained  in  its 
position  primarily  by  that  muscular  tension,  manifestly  the 
muscles  should  first  be  relaxed,  and  if  no  other  cause  of 
bony  displacement  be  present  that  may  be  sufficient.  Such  a 
condition  is  a  common  occurrence  among  acute  cases  and  hence 
the  general  rule  that  muscle  contracture  should  have  first  at- 
tention in  acute  cases  may  be  safe  enough  to  follow.  In  chronic 
conditions,  however,  the  vast  majority  of  cases  will  present 
bony  disorder  not  primarily  maintained  by  muscular  con- 
tracture; and  in  most  cases  the  muscle  contracture  will  be 
secondary  to  the  bony  disorder  though  in  the  beginning  mus- 
cle contracture  may  have  been  primary.  In  such  cases  as 
these  we  are  personally  convinced  that  direct  treatment  to  the 
muscles  is  secondary  in  point  of  time  and  importance,  and  so 
far  as  actual  results  are  concerned  the  direct  pressure  and 
massage  so  often  employed  is  entirely  superfluous.  We  shall 
begin  the  discussion  therefore  with  a  consideration  of  a  few 
general  principles  underlying  the  adjustment  of  the  osseous 
lesion. 

The  first  of  these  principles  may  be  spoken  of  by  the 
phrase  which  osteopathic  usage  has  authorized,  exaggera- 
tion of  the  lesion.  By  this  is  meant  a  manipulation  de- 
signed to  make  the  structure  more  prominent  in  the  direction 
toward  which  it  is  displaced.  For  instance  if  there  be  a  right 
lateral  luxation  of  a  cervical  -vertebra  the  head  should  be  flexed 
to  the  left  and  pressure  applied  to  the  cervical  tissues  on  the 
left  of  the  displaced  bone;  if  a  rib  is  sub -luxated  upward  on 
the  transverse  process  of  the  vertebra  pressure  is  exerted  up- 
ward at  the  angle  of  the  rib  and  downward  on  the  anterior 
extremity ;  if  the  innominatum  be  luxated  through  a  rotation  up- 
ward and  forward  pressure  will  be  exerted  in  an  upward  and 
forward  direction  on  the  iliac  portion  of  the  bone,  upward  and 
backward  on  the  ischium.  In  the  exaggeration  of  the  lesion 


128  PRINCIPLES   OF  OSTEOPATHY. 

several  objects  may  be  had  in  view.  In  the  first  place  the 
measure  tends  to  free  the  articular  structtires,  just  as  the  driving 
in  a  trifle  will  free  the  articulation  of  a  nail  with  wood  in  which 
it  is  imbedded  and  permit  it  to  be  withdrawn  more  easily.  In 
the  second  place  the  movement  effects  a  stretching  and  relaxa- 
tion of  the  deeper  structures  which  in  numerous  cases  is  all 
the  relaxation  that  is  called  for.  Finally,  there  is  secured 
the  benefit  of  recoil  which  results  from  the  stretching  of  the  tis- 
sues and  aids  in  initiating  the  movement  backward  towards 
the  normal  position. 

A  second  general  principle  is  that  of  rotation.  The 
value  of  rotation  can  hardly  be  over-estimated  although  the 
rotation  itself  may  easily  be  too  extreme.  In  effecting  rota- 
tian  of  the  part  luxated,  at  some  point  during  the  circuit  each 
of  the  fibres  in  each  of  the  ligamentous  and  other  connective 
structures  will  have  been  stretched  and  relaxed  and  the  artic- 
ular surfaces  kept  sufficiently  free  to  allow  the  progress  of 
the  part  back  to  its  original  position.  The  comparison  may 
be  crude  but  the  conditions  in  the  case  are  similar  to  the 
movement  of  a  trunk  or  box  along  a  platform  by  rocking  it 
back  and  forth  with  some  rotation.  The  advantage  of  this 
method  over  that  of  dragging  the  box  bodily  is  obvious. 

A  final  general  principle  in  the  adjustment  is  the  simple 
one  of  pressure  applied  to  the  luxated  structure  in  the  di- 
rection toward  its  normal  situation.  In  point  of  time  the  ex- 
aggeration of  the  lesion  is  first,  rotation  and  pressure  follow 
and  are  GO- extensive  and  co-ordinate  in  time.  In  all  but  a 
comparatively  few  cases  these  three  principles  can  be  ap- 
plied with  advantage,  and  are  applied  although  the  physician 
himself  may  not  have  been  aware  of  their  application.  In  a 
few  cases  little  direct  pressure  can  be  satisfactorily  made,  as 
in  the  case  of  an  anterior  lumbar  vertebra,  in  which  it  is 
necessary  to  rely  principally  upon  the  pull  of  tissues  in  and 
following  the  process  of  rotation.  In  other  cases  the  exag- 
gerafjion  of  the  lesion  may  not  be  feasible ;  but  in  no  case  is 
it  impossible  to  apply  rotation  and  in  numerous  conditions 


THE  TREATMENT   OP  DISEASE.  129 

•where  the  lesion  is  slight,  that  of  itself  will  be    sufficient  aid 
to  the  organism  in  effecting  a  normal  adjustment. 

ADJUSTMENT  OF  MUSCULAR  LESIONS. 

In  most  cases  of  a  chronic  nature  and  in  practically  all 
^icute  cases  muscular  lesion  will  be  quite  manifest.  It  is  not 
necessary  at  this  time  to  discuss  the  question  as  to  whether 
that  lesion  will  be  primary  or  secondary;  the  fact  that  it  ex- 
ists calls  for  discussion  as  to  the  methods  of  producing  relax- 
ation. For  whether  the  lesion  be  primary  or  secondary  its 
removal  is  seldom  if  ever  contra -indicated.  Note  first  that 
one  or  more  of  several  purposes  may  be  had  in  view  in  the 
relaxation. 

One  of  the  objects  in  such  relaxation  is  that  of  diagnosis. 
In  a  large  number  of  cases  the  muscular  lesion  will  be  the 
most  apparent  one,  which  fact  has  given  rise  to  much  hasty 
reasoning  with  the  conclusion  that  no  additional  factors  were 
present.  The  writer  was  once  told  when  he  was  a  student  in 
jschool  that  when  he  "got  into  the  field"  he  would  find  little 
beside  muscular  lesions.  We  are  compelled  to  testify  that 
"the  informant  has  proved  himself  a  false  prophet ;  if  care  be 
taken  in  analysis  of  conditions  few  chronic  cases  will  be 
present  unassociated  with  deeper  than  muscular  lesions,  while 
it  is  almost  equally  true  of  the  acute  forms.  Indeed  we  be- 
lieve it  not  unsafe  to  assert  that  in  most  cases  the  muscular 
contraction  is  direct  evidence  of  a  deeper  lesion.  The  difficulty 
of  detection  may  be  much  more  marked  than  the  realness  of 
the  lesion.  The  fact  that  deeper  lesion  is  usually  associated 
makes  it  necessary,  or  at  least  in  many  instances  helpful,  to 
effect  a  superficial  relaxation  in  order  to  detect  the  deeper 
•condition.  Note  the  case  of  a  contractured  cervical  region.  In 
numerous  of  such  the  ordinary  osteopath  will  not  be  able  to 
determine  the  condition  of  the  cervical  vertebrae  until  the  ob- 
scuring muscle  contracture  is  removed.  It  is  often  difficult, 
further,  to  detect  the  relative  position  of  the  posterior  part  of 
A  rib  at  its  junction  with  the  transverse  process  of  the  verte- 


130  PRINCIPLES   OF   OSTEOPATHY. 

bra  until  the  associated  contracture  is  overcome.  A  floating1 
kidney  acting  as  a  lesion  will  often  be  obscured  by  contract- 
ure of  the  quadratus  lumborum  and  abdominal  muscles.  But 
not  only  for  diagnosis  of  further  lesion  is  removal  of  con- 
tracture necessary  but  also  for  determination  of  the  organ  in- 
volved and  the  nature  of  the  involvement — i.  e.,  for  diagnosis 
of  the  disease  itself .  Note  the  fact  that  in  hepatic  colic  from 
the  passage  of  a  gall  stone  muscle  contracture  is  so  intense 
and  painful  that  a  palliative  relaxation  becomes  imperative 
for  definite  diagnosis  of  the  gall  stone  condition ;  similarly  an 
obstruction  to  the  bowel  will  produce  secondary  abnormal 
tenseness  sufficient  to  prohibit  palpation  of  the  impacted  or 
otherwise  occluded  condition ;  the  rectal  and  vaginal  sphincters 
may  be  so  constricted  as  to  hinder  local  examination  of  the 
position  and  condition  of  the  uterus.  In  all  such  cases  the 
beginning  osteopath — i.e.,  the  inexpert — finds  it  necessary  to 
resort  to  the  removal  of  the  secondary  obscuring  lesions  be- 
fore he  is  able  to  make  a  satisfactory  diagnosis  of  the  disease. 
A  second  object  is  as  a  preliminary  to  further  treat- 
ment, the  further  treatment  often  though  not  necessarily  being 
the  primary  one.  The  "Old  Doctor"  invariably  allows  his 
fingers  or  palms  to  "sink  in"  the  tissues  for  a  moment  pre- 
vious to  the  movement  for  adjustment  of  a  cervical  vertebra.  In 
this  "sinking  in"  relaxation  occurs  which  reduces  the  amount 
of  force  necessary  to  produce  movement  by  rotation  and 
pressure;  in  long  standing  cases  of  hip  dislocation,  where  a 
crude  new  articulation  has  been  formed  with  a  consequent 
adjustment — shortening  and  lengthening — of  muscle  and  lig- 
ament, it  is  impracticable  and  in  most  cases  with  the  osteo- 
path of  average  skill,  impossible  to  immediately  reduce  the 
dislocation  and  recourse  must  be  had  to  a  series  of  treatments 
designed  to  relax  and  otherwise  change  structural  condi- 
tions which  are  secondary  to  the  original  dislocation ;  in 
bowel  occlusion  from  impaction  of  feces  relaxation  of  the  ab- 
dominal wall  is  essential  to  a  further  direct  manipulation  of 
the  impacted  area. 


THE   TREATMENT   OF   DISEASE.  131 

Finally,  relaxation  is  used  as  a  treatment  primary  in 
itself.  A  muscle  contracture  whether  primarily  or  second- 
arily produced  will  exert  pressure  on  tissues  within  itself, 
e.  g.,  sensory  nerve  terminals,  or  disturb  structures  to  which 
it  is  attached.  As  instance  of  the  former  note  the  conditions 
of  congestion  produced  in  the  respiratory  canal  by  virtue  of 
contractures  irritating  afferent  nerves  which  carry  impulses 
to  the  segment  of  the  spinal  cord  governing  the  vaso- motor 
mechanism  to  the  part  involved :  relaxation  of  the  muscle 
tissue  in  such  a  case  removes  the  primary  cause  of  the  con- 
gestion. But  by  the  tension  upon  the  associated  vertebra  or 
rib  displacement  of  the  latter  will  further  add  to  the  difficulty 
and  hence  be  additional  cause;  in  this  case  the  relaxation  will 
permit  of  a  return  of  the  displaced  structures  to  their  natural 
relationship.  Further  instances  are  relaxation  of  supra-hyoid 
muscles  which  interfere  with  venous  return  from  certain 
cephalic  structures,  thus  relieving  congestion ;  pressure  on 
the  bowel  wall  in  a  spasmodic  contraction  of  the  muscular 
coats  which  relaxes  the  tissue  and  overcomes  the  cramp 
which  so  distresses. 

"With  regard  to  the  methods  employed  in  producing  relax- 
ation several  are  in  vogue  by  different  osteopaths.  Among 
them  we  may  specify  the  most  important.  The  removal  of 
the  cause  constitutes  in  all  cases  the  fundamental  method. 
Owing  to  the  tendency  on  the  part  of  students  to  apparently 
overlook  the  fact  it  seems  necessary  to  emphasize  that  a  con- 
tractured  muscle  remains  in  that  state  only  by  virtue  cf  a  continuously 
acting  stimulus.  One  of  the  inherent  properties  of  muscle 
tissue  is  its  ability  to  respond  to  a  stimulus  by  a  contraction. 
It  is  no  less  an  inherent  property  of  that  tissue  to  relax  as 
soon  as  the  stimulus  is  removed.  In  both  cases  there  is  some 
evidence  to  show  that  the  process  is  an  active  one.  With  a 
certain  proportion  of  students  and  inexperienced  osteopaths 
their  first  consideration  on  meeting  with  a  case  presenting 
contracture  is  the  application  of  methods  direct  to  the  muscle 
designed  to  produce  a  relaxation.  This  is  fundamentally  erro- 


132  PRINCIPLES   OF  OSTEOPATHY. 

neous.  The  first  consideration  should  be  the  determination  of 
the  nature  and  source  of  the  constantly  acting  stimulus.  The 
second  consideration  should  be  the  application  of  measures 
to  remove  that  stimulus.  If  a  muscle  is  contractured  through 
simple  exposure  to  a  change  of  temperature  the  primary 
treatment  is  the  negative  one  of  removing  the  patient  from 
the  influence  of  the  changing  temperature.  If  the  contrac- 
ture  is  caused  by  a  direct  irritation  to  the  motor  nerve 
through  pressure  from  a  deep  bony  or  ligamentous  lesion  the 
essential  treatment  consists  in  opening  up  the  space  which 
transmits  the  nerve.  A  contractured  condition  of  the  anter- 
ior muscles  of  the  thigh  caused  by  impingement  upon  the  anter- 
ior crural  will  be  logically  and  surely  overcome  by  the  ad- 
justment of  the  luxated  hip,  pelvic,  or  lumbar  structures 
causing  the  impingement.  Note  that  the  direct  work  upon 
the  muscle  in  any  of  these  cases  will  be  getting  at  the  diffi- 
culty from  the  wrong  side  and  can  only  indirectly  and  in 
most  cases  temporarily  reduce  the  contracture. 

Admitting  the  logic  of  the  above  considerations  it  yet  re- 
mains a  fact  that  specific  methods  other  than  those  directly 
concerned  in  the  way  indicated  above  may  be  employed  as  a 
matter  of  expediency.  Pressure  with  quiet  and  slight  rota- 
tion of  the  tissues,  usually  more  in  a  direction  at  right  angles 
to  that  of  the  fibers  than  otherwise,  is  employed  in  numerous 
cases.  In  what  way  this  pressure  produces  the  relaxation  is 
not  definitely  known.  It  is  suggested  that  relaxation  results 
because  of  an  inhibitory  effect  upon  the  nerve  terminals  as- 
sociated directly  with  the  muscle.  Objection  must  be  made 
to  this  as  an  entirely  satisfactory  explanation  because  of  the 
known  physiological  fact  that  it  is  much  more  easy  to  produce  a 
stimulation  of  a  nerve  than  to  produce  a  lessening  of  its  activity. 
In  fact  it  is  with  the  utmost  difficulty  that  a  nerve  can  be  in- 
hibited by  pressure  upon  it  when  experimented  upon  in  the 
laboratory.  On  the  other  hand  stimulation  is  almost  sure  to 
result  unless  the  most  extreme  care  is  exercised.  It  is  not  de- 
nied that  gradually  applied  deep  pressure  is  effective  in  pro- 


THE  TREATMENT   OF   DISEASE.  133 

ducing  relaxation  and  it  is  true  that  the  more  gradual  the  ap- 
plication the  more  satisfactorily  does  it  yield.  And  there  is  good 
reason  for  the  latter  fact.  Note  that  a  stimulus  causing  response 
of  any  kind  in  any  tissue  will  be  effective  in  proportion  not  to  the 
total  intensity  or  amount  but  to  the  abruptness  of  its  application.  It 
can  be  shown  that  the  change  from  a  higher  to  a  lower  potential 
in  case  of  the  electric  stimulus,  if  the  change  be  sudden,  will 
be  an  effective  cause  of  response.  The  same  is  undoubtedly 
true  with  regard  to  the  several  forms  of  stimuli ;  it  can  be 
shown  in  the  case  of  heat  very  nicely.  A  "spinal"  frog's  limb 
may  be  literally  cooked  without  causing  a  reflex  response  if 
the  heat  be  applied  gradually,  whereas  a  change  of  a  degree 
or  two  in  temperature  if  produced  abruptly  will  elicit  a  mark- 
ed reflex.  Hence  if  the  explanation  were  entirely  one  hav- 
ing reference  to  an  inhibitory  action  on  the  nerve  terminals, 
none  but  the  most  gradually  applied  pressure  would  be  effect- 
ive. We  know,  however,  that  in  many  cases  relaxation  does 
occur  where  the  pressure  is  applied  in  anything  else  than 
a  gradual  way.  The  fact  that  the  latter  method  is  less  effica- 
cious is  no  argument  for  the  explanation  based  on  inhibition 
of  nerve  force.  It  is  simply  evidence  that  rough  treatment 
is  associated  with  greater  possibility  of  stimulation  of  the 
nerve  terminals, 

Some  other  explanation  then  seems  necessary.  One 
such  that  has  been  suggested  has  reference  to  the  fact  al- 
ready mentioned,  that  in  a  typical  contracture  there  is  a  con- 
dition that  is  markedly  different  from  a  simple  prolonged  contrac- 
tion. The  condition  is  one  in  which  a  part  or  all  of  the  muscle 
is  changed  in  the  nature  and  amount  of  the  fluids  present. 
Hence,  when  relaxation  is  effected  by  direct  pressure  and 
manipulation  it  may  result  from  the  expressing  from  within 
and  between  the  muscle  fibers  the  products  of  abnormal  met- 
abolism. Owing  to  its  congested  state  the  muscle  is  enlarged 
bodily  and  is  contractured,  in  part  by  stimuli  of  nerve  ter- 
minals by  chemical  alteration  or  pressure  from  distension  of 
its  vascular  system.  These  will  be  partially  overcome  by 


134  PRINCIPLES   OF  OSTEOPATHY. 

compression  of  the  body  of  the  muscle.  Further,  the  pres- 
sure upon  the  fibre  directly  may  very  materially  assist  in  its 
relaxation  by  more  or  less  forcibly  re-arranging  the  particles  of 
the  muscle  protoplasm.  For  we  know  that  the  essential  mechan- 
ical difference  between  a  fibre  contracted  and  one  at  rest  is 
the  relative  number  of  protoplasmic  molecules  in  a  definite 
cross -section  of  the  fibre,  i.  e.,  in  contraction  the  molecules 
come  abreast  while  in  relaxation  they  assume  "single  file." 
In  the  process  of  relaxation,  then,  there  is  forcibly  produced 
a  tendency  to  the  single  file  arrangement. 

As  examples  of  cases  in  which  the  pressure  and  manipu- 
lation method  is  efficacious  are  the  following:  in  headaches  we 
often  find  the  sub-occipital  region  markedly  tense  in  which 
case  the  gradual  but  deep  pressure,  a  "sinking  in"  as  Dr. 
Still  calls  it,  forces  the  tissue  to  relax  and  often  yields  imme- 
diate relief ;  in  case  of  the  passage  of  a  gall  stone  along  the 
duct  the  irritation  is  so  intense  as  to  cause  direct  contracture 
along  the  duct,  the  abdominal  wall  overlying  it,  and  the  spinal 
region  from  which  it  is  innervated,  in  which  case  pressure  is 
used  both  along  the  spine  and  the  course  of  the  duct;  in  croup 
and  diphtheria  the  rapid  inflammation  and  associated  toxic 
condition  cause  rapid  and  intense  contracture  and  congestion 
of  the  supra- hy oid  muscles,  which  will  in  most  cases  rapidly, 
though  perhaps  temporarily,  yield  to  the  pressure  and  manip- 
ulation. 

Stretching  a  muscle  is  a  method  that  is  employed  by 
many  osteopaths  for  the  purpose  of  producing  relaxation. 
It  is  doubtful  whether  such  a  method  will  usually  result  satis- 
factorily. Theoretically  there  is  much  to  be  said  against  the 
process.  The  process  of  stretching  a  muscle  is  one  method 
of  insreasing  the  irritability  of  that  muscle.  Lombard  is  au- 
thority for  the  statement  that  "the  irritability  of  muscles  is 
likewise  increased  by  moderate  stretching  and  destroyed  if  it 
be  excessive."  Hence  it  would  certainly  seem  illogical  to  at- 
tempt relaxation  by  increasing  its  irritability.  Neither  would 
it  be  the  part  of  wisdom  to  destroy  the  irritability  by  exces- 


THE   TREATMENT   OP   DISEASE.  135 

sive  stretching.  A  muscle  in  the  condition  of  contracture  will 
be  stimulated  to  still  greater  contraction  by  throwing  it  on  a 
tension,  and  yet  there  seems  to  be  no  question  that  in  a  large 
percentage  of  cases  the  process  does  result  favorably  and  the 
explanation  is  sought.  The  stretching  of  a  muscle,  thus  in- 
creasing its  tension,  corresponds  in  a  way  to  the  "exaggera- 
tion" in  case  of  an  osseous  lesion,  and  in  that  case  there  is 
secured  the  "benefit  of  recoil."  In  addition  reference  is  again 
made  to  the  fact  that  muscle  contracture  is  not  identical  with 
muscle  contraction,  and  in  the  process  of  stretching,  the  con- 
gested material  and  waste  products  are  more  or  less  forcibly 
expressed  from  the  contractured  tissue  though  no  relaxing 
effect  might  be  gotten  on  a  simple  contraction.  In  all  cases 
when  attempting  relaxation  by  this  method  a  simple  rule  of 
guidance  is  usually  sufficient.  Separate  the  origin  and  inser- 
tion of  the  muscle.  In  case  the  scaleni  muscles  are  found  con- 
tractured on  the  left  side,  bending  the  head  to  the  right  with 
the  shoulders  a  fixed  point  will  separate  the  attachments  and 
hence  produce  stretching;  the  hyper -extension  of  the  thigh 
will  stretch  the  anterior  femoral  muscles  while  extreme  flexion 
of  the  thigh  on  the  abdomen  will  put  tension  on  the  posterior 
muscles  of  the  limb;  the  pulling  of  the  middle  portion  of  a 
muscle  in  a  direction  transverse  to  the  course  of  its  fibres 
will  produce  tension  of  the  muscle  although  the  absolute  dis- 
tance between  the  two  attachments  of  the  muscle  actually 
may  have  been  lessened,  as  in  the  case  of  an  upward  and 
outward  manipulation  of  the  spinal  muscles  in  the  region  of 
the  lower  thoracic. 

Another  method  less  subject  to  abuse  is  that  of  approxi- 
mation of  the  origin  and  insertion.  In  this  method  the 
attached  structures  are  forced  to  yield  to  the  continued  ten- 
sion of  the  muscle.  That  this  method  is  efficacious  as  a  tem- 
porary expedient  few  will  deny.  Just  as  the  tension  can  be 
removed  from  a  rope  attached  to  posts  by  bending  the  posts 
toward  each  other  so  to  an  appreciable  extent  can  the  tension 
be  taken  from  a  muscle  by  forcing  nearer  together  the  points 


136  PRINCIPLES   OF   OSTEOPATHY. 

of  attachment.  Further,  this  method  seems  to  be  a  moat 
natural  one  and  one  resorted  to  involuntarily  in  many  cases. 
Note  the  characteristic  position  assumed  by  a  victim  of  peri- 
tonitis in  which  the  superficial  abdominal  tissues  are  intensely 
tightened.  The  patient  will  lie  supine  with  the  limbs  flexed 
at  the  hip  and  the  head  and  shoulders  raised,  the  total  effect 
on  the  musculature  of  the  abdomen  being  an  approximation 
of  the  origin  and  insertion  of  most  of  the  muscles  concerned ; 
a  further  instance  indicating  the  value  of  this  method  is  the 
flexing  of  the  head  dorsally  upon  the  neck  in  a  case  of  sub- 
occipital  contraction;  or  the  flexion  of  the  arm  at  the  elbow  for 
the  pupose  of  relaxing  the  biceps  preliminary  to  the  reduc  • 
tion  of  a  dislocated  shoulder. 

It  is  seldom  that  any  of  these  several  methods  will  be  used 
alone  and  it  is  in  comparatively  few  cases  that  it  is  possible 
or  advisable  to  avoid  using  two  or  more  of  them.  For  in- 
stance in  the  case  of  a  contractured  scalenus  muscle  a  com- 
mon method  is  first  to  bend  the  head  away  from  the  side  of 
the  contracture  which  stretches  the  muscle,  then  rotate  it  back 
which  approximates  the  origin  and  insertion,  and  at  the  same 
time  pressure  is  exerted  directly  upon  the  muscle  fibres.  In 
this  case  three  of  the  methods  were  employed  and  it  is  alto- 
gether likely  that  during  the  course  of  the  movement  the  deeper 
structures  were  opened  up,  impingement  taken  off  the  nerve 
which  supplied  the  muscle,  and  hence  the  irritation  was  re- 
moved and  the  fourth  of  the  methods  made  use  of.  The  point 
was  emphasized  in  the  case  of  the  method  by  pressure  that 
the  application  should  be  gradual.  It  is  equally  true  of  the 
other  methods  and  not  only  with  reference  to  the  application 
but  the  removal  of  contact  should  also  be  gradual  for  if  the  re- 
moval be  sudden  there  results  an  abrupt  change,  and  abrupt 
change  whether  from  a  lower  to  a  higher  or  from  a  higher  to 
a  lower  level  constitutes  a  stimulus,  and  a  stimulus  means 
further  contracture.  Another  caution  of  some  considerable 
value  has  reference  to  the  relative  temperature  of  the  hand  of 
the  physician.  If  the  manipulation  is  made  direct  upon  the 


THE   TREATMENT   OF   DISEASE.  137 

tissues  it  is  necessary  for  best  results  that  the  temperature  of 
the  part  and  of  the  physician's  hand  should  be  approximately 
the  same.  Especially  it  is  advisable  if  the  physician  has  cold 
hands  to  warm  them  before  beginning  the  treatment,  other- 
wise the  shock  produced  by  the  difference  in  temperature  will 
be  a  distinct  added  stimulus  for  further  contraction,  a  result 
not  at  all  to  be  desired. 

TREATMENT  OF  OTHER  LESIONS. 

Thus  far  there  has  been  discussed  certain  general  prin- 
ciples underlying  the  treatment  of  bony  luxations  and  muscu- 
lar contractures.  It  becomes  necessary  to  suggest  a  few 
points  of  practical  value  in  regard  to  the  other  forms  of  lesions 
which  the  osteopath  must  occasionally  meet.  In  all  of  those 
cases  of  perverted  size  relations  of  parts  we  have  to  deal 
with  some  nutritive  disorder  which  was  responsible  for  the 
perverted  growth  lesion,  and  hence  in  such  cases  it  is  neces- 
sary to  seek  the  further  lesion  or  other  cause  of  the  nutritive 
condition  and  give  attention  to  its  reduction ;  or  in  a  second 
class  of  cases  the  lesion  of  perverted  growth  has  resulted 
from  direct  violence  producing  a  bruise  or  other  enlargement 
in  which  the  same  considerations  of  treatment  apply.  The 
reduction  of  these  is  largely  accomplished  through  depend- 
ence on  normalizing  all  of  the  associated  structures  and  re- 
lying on  normal  processes  of  absorption  to  remove  the  surplus 
material.  In  some  cases  it  will  be  necessary  to  resort  to  sur- 
gical removal  but  only  as  a  final  resort.  A  tumor  of  the  ab- 
domen is  a  perverted  structure  which  by  pressure  upon  the 
hypogastric  plexus  or  other  vital  structure  may  produce  dis- 
order of  various  forms.  The  treatment  of  such  a  lesion  would 
be  the  removal  of  the  original  structural  condition  which  per- 
mitted the  deposit  of  the  morbid  material,  together  with  the 
frequent  movement  and  lifting  up  of  the  tumor  itself  in  order 
to  keep  all  channels  as  free  as  possible.  Overgrown  muscles 
and  exostoses  have  been  known  to  cause  disorder  and  hence 

are  considered  as  lesions ;  the  removal  of  such  will   depend 

10 


188  PRINCIPLES   OF  OSTEOPATHY. 

upon  the  same  factors  which  were  suggested  in   reference   to 
the  tumor. 

The  overcoming  of  connective  tissue  lesions  is  a  matter 
of  no  little  difficulty  and  is  a  condition  quite  often  met  with. 
A  typical  lesion  of  this  type  is  found  in  the  rigid  spine  more 
or  less  normal  to  the  aged  individual  and  often  met  with 
in  younger  people  who  have  suffered  from  some  spinal  vio- 
lence. This  rigid  spine  condition,  where  it  is  not  of  a  tem- 
porary nature  such  as  would  be  produced  by  simple  muscle 
contracture,is  caused  by  a  thickening,  contracting,  or  lessen- 
ing of  the  fibrous  and  other  ligamentous  structures  associated 
with  the  vertebrae ;  or  to  a  deposit  in  the  articular  structures 
of  various  salts,  as  in  the  case  of  chronic  articular  rheuma- 
tism; or  finally,  a  condition  of  bony  ankylosis.  In  all  of 
these  cases  it  is  a  serious  question  whether  a  complete  cure 
can  be  effected  or  very  great  benefit  given,  owing  to  the  diffi- 
culty of  removing  such  lesion  by  any  known  methods.  In 
most  cases  it  will  largely  be  a"breaking  up  process"designed 
to  open  up  the  deep  structures  thereby  overcoming  tension 
on  nerve  and  blood  vessel  and  permitting  a  free  opportunity 
for  absorptive  processes  to  be  maintained.  A  further  type  of 
connective  tissue  lesion  is  found  in  the  case  of  cirrhosis  of  the 
liver  where  the  connective  tissue  frame- work  has  been  formed 
in  excess  and  has  subsequently  contracted  thereby  reduc- 
ing quite  appreciably  the  total  volume  of  that  organ  and  very 
considerably  obstructing  the  portal  circulation  and  the  meta- 
bolic activities  of  the  liver.  In  the  case  of  sclerosis  of  the 
spinal  cord  we  have  also  a  connective  tissue  lesion  of  a  serious 
nature  In  this  case  the  neuroglia  of  the  cord  is  thickened 
and  contracted  producing  or  following  a  degeneration  of  the 
nerve  elements.  In  both  cirrhosis  and  sclerosis  the  prognosis 
for  removal  is  rather  unfavorable  especially  in  case  of  the 
latter.  For  we  know  that  while  a  regeneration  of  nerves  will 
take  place  in  peripheral  structures  there  are  as  yet  no  authen- 
tic oases  of  regeneration  of  the  nerve  fibre  in  the  spinal  cord 
when  that  degeneration  had  been  experimentally  produced. 


THE  TREATMENT   OF  DISEASE.  139 

All  that  can  be  reasonably  expected  in  such  conditions  will 
be  the  limiting  of  the  further  progress  of  the  disease  and  a 
partial  absorption  of  the  morbid  deposit  by  establishing  and 
maintianing  a  normal  spinal  circulation. 


140  PRINCIPLES   OP  OSTEOPATHY. 


CHAPTER  VIIL 

THE  TREATMENT  OF  DISEASE.— CON. 
STIMULATION  AND  INHIBITION. 

Like  all  systems  of  healing,  osteopathy  has  been  pre- 
sented by  various  classes  of  its  advocates  in  various  dis- 
guises, and  as  a  result  has  been  at  times  entirely  misrepre- 
sented. While  it  is  a  matter  of  course  that  its  professed  en- 
emies should  attempt  to  mislead,  it  is  quite  unfortunate  that 
there  are  a  few  of  its  professed  followers  who,  in  attempting 
to  uphold  the  system,  have  unwittingly  placed  it  on  a  par 
with  other  systems  by  intimating  or  definitely  asserting  that 
osteopathy  is  a  method  of  treatment  by  mechanical  stimu- 
lation and  inhibition  of  nerve  impulses.  It  cannot  be  too 
strongly  emphasized  that  such  a  position  places  the  osteopath 
on  the  same  plane  wth  all  other  schools  ofhealng,  the  underlying 
principle  being  the  same  in  kind,  and  differing  only  in  degree. 
He  who  assumes  that  this  definition  of  osteopathy  is  a  new 
conception  in  therapeutics  and  one  which  embraces  the 
essentials  of  the  osteopathic  philosophy  has  not  only  failed 
entirely  to  grasp  that  philosophy,  but  has  shown  an  ignorance 
of  medical  history  quite  unjustified.  For  such  history  is  re- 
plete with  evidences  that  mechanical  stimulation  and  inhibi- 
tion applied  by  definite  manipulations  has  long  been  known 
and  used — centuries  before  osteopathy  had  been  brought  into 
the  world.  But  with  the  rise  and  development  of  osteopathy 
and  the  newly  awakened  interest  in  drugless  systems  which 
in  part  resulted  from  that  development,  these  various  methods 
have  been  subjected  to  investigation  as  never  before  through 
the  study  of  literature  bearing  on  the  subject,  and  the  ap- 
plication of  mechanical  measures  to  disease  conditions. 
Hence,  by  a  hasty  though  not  unnatural  inference  was  de- 
duced the  conclusion  that  the  new  method  was  but  a  special 


THE   TREATMENT   OF   DISEASE.  141 

modification  and  extension  of  the  old.  It  is  sufficient  in  this 
connection  to  affirm  that  stimulation  and  inhibition  as 
definite  osteopathic  procedures  are  measures  that  have  been 
super- added  to  the  original  and  primary  conception,  and  in 
so  far  as  they  may  be  used  at  all  are  insignificant  in  import- 
ance. 

The  last  statement  suggests  that  there  is  a  possible  use  for 
these  methods  and  under  the  circumstances  of  an  undeveloped  and 
incomplete  science  and  a  lack  of  knowledge  and  skill  on  the  part  of 
the  practitioner,  the  statement  may  be  true.  Under  certain  cir- 
cumstances it  may  be  impossible  or  impracticable  for  the 
osteopath  to  apply  specific  osteopathic  treatment  and  in  such 
cases  it  will  be  necessary  for  him  to  place  himself  upon  the 
same  plane  with  the  practitioner  of  other  schools  and  use  the 
least  objectionable  of  the  methods  of  the  latter.  In  order  to 
understand  the  nature  and  possible  value  of  these  methods  it 
seems  advisable  to  speak  of  them  somewhat  in  detail. 

By  stimulation  of  a  nerve  or  an  organ  is  meant  the 
process  of  acceleration  of  the  function  of  that  nerve  or  organ. 
By  inhibition  is  meant  the  process  of  retarding  of  the  func- 
tion of  a  nerve  or  organ.  Both  of  these  processes  are  at- 
tributes of  normal  living  tissue,  more  especially  of  the  nerv- 
ous system.  We  may  speak  of  the  voluntary  contraction  of  a 
muscle  as  a  normal  or  physiological  stimulation  of  that  mus- 
cle ;  the  effect  of  food  on  the  gastric  mucosa  as  that  of  a  nor- 
mal stimulation  of  the  function  of  secretion ;  the  excess  of 
carbon  dioxid  in  the  blood  as  a  physiological  stimulus  to  the 
respiratory  center.  On  the  other  hand  a  voluntary  impulse  sent 
to  the  spinal  cord  center  which  cuts  off  the  reflex  movement 
that  would  otherwise  occur  is  an  instance  of  a  physiological 
inhibition;  the  vagus  nerve  carries  inhibitory  fibres  to  the 
heart  muscle  which  retards  the  activity  of  that  tissue;  im- 
pulses passing  by  way  of  the  sympathetic  filaments  to  the 
muscles  within  the  wall  of  the  intestinal  tract  causing  a  slower 
peristalsis  are  spoken  of  as  viscero-inhibitory.  These  are  all 
examples  of  the  physiological  or  natural  inhibition.  By  an 


142  PRINCIPLES   OF   OSTEOPATHY. 

osteopathic  stimulation  or  inhibition  reference  is  made  to  the 
artificial  process  which  causes  or  is  supposed  to  cause  by 
pressure  a  similar  effect.  Note  that  the  process  is  artificial. 
A  mechanical  stimulus  applied  by  the  hand  of  the  practi- 
tioner is  emphatically  not  a  natural  but  an  artificial  stimulus. 
It  is  said  that  the  liver  is  stimulated  by  producing  pressure 
directly  on  it  or  by  otherwise  compressing  it ;  the  pneumogas- 
tric  nerve  is  stimulated  by  pressure  along  its  course  for  the 
purpose  of  increasing  its  function  in  lessening  the  cardiac 
activity;  in  prolapsus  of  the  rectum  the  atonic  walls  are  stimu- 
lated by  local  treatment.  On  the  other  hand  the  osteopath 
inhibits  the  phrenic  nerve  for  controlling  hiccoughs;  pressure 
exerted  along  the  splanchnic  region  inhibits  the  cramping  in 
various  forms  of  colic;  pressure  exerted  in  the  lumbar  and 
sacral  regions  and  along  the  course  of  the  sciatic  nerve  will 
often  temporarily  relieve  sciatica. 

These  treatments  are  referred  to  as  stimulating  or  inhibi- 
tory and  the  assumption  made  that  it  is  in  truth  the  increas- 
ing or  the  lessening  of  nerve  action  by  a  direct  process.  Is 
such  a  control  possible?  We  have  heard  the  human  body 
compared  to  the  piano  upon  which  the  practitioner  plays, 
bringing  out  the  harmony  of  action  as  the  musician  produces 
the  harmony  of  tone.  We  have  heard  it  compared  to  an  electric 
system  upon  which  the  intelligent  osteopath  may  send  mes- 
sages and  shunt  the  currents  and  connect  the  circuits.  We 
have  heard  the  statement  that  the  vital  fluids  and  forces  of 
the  body  are  absolutely  under  the  control  of  the  skillful  oper- 
ator. The  essential  thing  lacking  in  these  comparisons  and 
statements  is  the  element  of  truth.  The  human  body  is  not 
at  all  like  a  piano,  neither  does  the  osteopath  play  upon  it  as 
would  the  musician.  It  is  not  an  electric  system  that  can  be 
operated  upon  to  any  degree  as  the  electrician  manipulates 
his  batteries  or  his  keys.  The  forces  and  fluids  of  the  body 
are  fortunately  beyond  the  control  of  the  physician,  skillful 
though  he  be.  A  few  facts  with  reference  to  anatomy  and 
physiology  may  not  be  out  of  place  as  indicating  the  insur- 


THE  TREATMENT   OF   DISEASE.  143 

mountable  difficulties  in  the  way  of  securing  the  absolute  con- 
trol suggested  above.  It  seems  advisable  to  again  repeat 
that  function  is  self-regulative  and  structure  nearly  so,  and  it  is 
the  business  of  the  osteopath  to  deal  with  structure,  not  func- 
tion, and  to  deal  with  structure  only  as  that  structure  is  in  an 
abnormal  condition.  But  can  the  nerve  be  stimulated  and 
satisfactory  results  follow? 

DIFFICULTIES  IN  DIRECT  CONTROL. 

In  the  first  place  we  are  just  beginning  to  learn  the 
functions  of  nerves.  There  are  a  few  hundred  million  nerve 
fibres  in  the  human  body  the  function  of  most  of  whioh  are 
not  known.  It  was  thought  that  the  function  of  the  pneumo- 
gastric  in  reference  to  the  heart  was  known  to  be  inhibitory, 
yet  Schiff  insists  that  the  nerve  has  also  an  accelerator  func- 
tion. It  was  assumed  that  the  efferent  nerve  that  passes  to 
the  muscle  carries  only  an  impulse  resulting  in  contraction, 
but  evidence  is  accumulating  to  show  that  it  carries  also  an 
inhibitory  impulse.  It  was  believed  that  the  sacral  nerves 
carried  motor  impulses  to  one  layer  of  muscle  tissue  in  the 
rectal  wall  and  inhibitory  impulses  to  the  other  layer,  but 
Langley,  Anderson  and  others  have  exploded  the  "crossed  in- 
nervation"  theory.  In  the  light  of  these  facts  as  to  the  func- 
tion of  the  nerves  it  is  presumption  to  assume  that  any  such 
marked  control  over  functions  as  suggested  above  can  be 
gained. 

Greater  difficulty  in  securing  a  very  complete  control  of 
nerve  action  by  direct  means  is  obvious  when  the  fact  is  noted 
that  the  same  nerve  may  have  different  functions.  Bear 
in  mind  that  the  nerve  is  not  a  separate  structure  but  is  made 
up  of  an  indefinite  number  of  nerve  fibres  each  one  of  which 
may  be  associated  with  a  distinct  and  different  action.  The 
vagus,  for  instance,  has  efferent  fibres  controlling  motion  and 
vaso- motion,  secretion,  inhibition  and  trophicity  (?)  and  af- 
ferent fibres  associated  with  pain  sensation,  vomiting,  vaso- 
dilatation  and  perhaps  a  host  of  others.  All  these  are  bound 


144  PRINCIPLES   OF  OSTEOPATHY. 

up  in  the  same  nerve  sheath.  Imagine  the  nicety  of  control 
possible  to  the  practitioner  under  such  an  anatomical  arrange- 
ment! Any  afferent  nerve  may,  on  being  stimulated  by  me- 
chanical means,  modify  any  of  the  numerous  functions  of  a 
spinal  segment.  Who  will  direct  the  excess  of  impulse  into 
the  right  channel?  Nearly  every  nerve  that  carries  vaso-con- 
stricter  fibres  carries  also  those  of  a  dilator  function.  The 
presumption  in  claiming  an  arbitrary  choice  of  effects  in 
vaso-motor  stimulation  is  evident. 

A  third  factor  is  noted  in  that  the  nerve  it  is  desirable  to 
affect  may  not  be  in  its  usual  situation.  The  inhibition  of 
the  phrenc  nerve  is  often  impossible  because  of  the  simple  fact 
that  it  is  not  in  the  location  where  pressure  is  applied.  Any 
one  who  has  had  occasion  to  do  much  work  in  the  dissecting 
room  will  be  impressed  with  the  numerous  exceptions  to  the 
rules  of  location  of  structures.  Attention  was  recently  called 
to  a  case  showing  the  spinal  acceessory  nerve  passing  across 
the  end  of  the  transverse  process  of  the  atlas  and  to  all  ap- 
pearances it  was  an  entirely  normal  condition. 

In  close  connection  with  the  above  the  fact  should  be 
noted  that  the  vast  majority  of  nervea  are  beyond  the  possibility 
of  direct  manipulation,  a  very  wise  provision  of  nature. 
Stimulating  the  splanchnic  nerves  is  spoken  of  as  though 
those  structures  were  laid  bare  to  the  touch.  Perhaps  in 
reality  there  is  produced  acceleration  of  function  in  many 
cases.  But  it  certainly  must  be  done  through  a  very  indirect 
route,  and  that  through  the  complex  arrangement  of  a  reflex 
mechanism. 

The  latter  suggests  a  fifth  very  real  difficulty  in  the  way. 
Most  stimulating  and  inhibiting  treatments  are  explained  on 
such  a  reflex  basis,  an  explanation  which  in  some,  perhaps 
most  cases  seems  rather  strained.  Note  that  the  stimulation 
of  the  nerves  associated  with  the  spinal  region,  for  purposes 
of  affecting  the  splanchnic  nerves  must  pass  by  the  afferent 
spinal  fibres — fibres  which  have  a  choice  of  many  neurons  to 
which  their  charge  may  be  delivered.  Tt  is  but  a  remote  pos- 


THE  TREATMENT   OF   DISEASE.  145 

sibility  rather  than  a  likely  probability  that  sufficient  of  the 
excess  of  stimuli  shall  reach  those  cell  bodies  whose  axons 
pass  to  form  the  splanchnic  pathways.  The  argument  that 
use  is  made  of  that  explanation  for  the  visceral  disorders  re- 
sulting from  spinal  muscle  contracture,  does  not  particularly 
enhance  the  proposition  that  the  osteopath  can  cause  the  ef- 
fect that  is  produced  by  the  lesion.  Note  that  the  lesion  is 
either  a  much  more  intense  stimulus  or  is  prolonged  over  a 
greater  period  of  time.  Should  the  osteopath  keep  up  continu- 
ous stimulation  of  such  nerves  for  some  hours  sufficient  ex- 
cess of  stimuli  might  be  discharged  into  the  splanchnic  chan- 
nels to  amount  to  a  real  stimulation.  But  no  such  length  of 
stimulation  period  is  indulged  in  by  the  average  practitioner. 
Further,  to  argue  that  the  excess  will  all  be  poured  into  the 
channels  needing  it  because  nature  "tends  to  the  normal" 
hardly  meets  the  demands.  It  is  true  that  nature  tends  to 
normal,  but  it  is  further  true  that  so  far  as  function  is  con- 
cerned the  tendency  is  in  part  toward  that  condition  which  is  normal 
to  the  existing  structure — i.  e.,  to  that  condition  which  is  per- 
mitted by  the  existing  structure.  So  long  as  structural  con- 
ditions are  at  fault  the  function  must  remain  so.  When  that 
condition  is  overcome  no  additional  stimulus  would  be  neces- 
sary. 

A  further  difficulty  presents  itself  in  cases  where  the 
stimulus  may  be  applied  either  directly  or  reflexly.  The  in- 
tensity of  the  stimulus  cannot  be  gauged  in  proportion  to 
the  need  in  the  particular  case.  In  laboratory  work  in 
physiology  the  mechanical  stimulus  is  seldom  made  use  of  for 
this  simple  reason.  It  is  effective  but  cannot  be  regulated  in 
intensity,  hence  the  use  of  the  electric  stimulus  which  is  sus- 
ceptible of  nicety  of  control.  How  much  pressure  shall  be 
employed  in  order  that  the  exact  amount  of  increase  of  func- 
tion shall  be  produced?  There  can  be  no  answer  to  the  ques- 
tion. Why  not  employ  the  electric  stimulus,  then,  instead  of 
the  mechanical  in  osteopathic  practice?  For  the  very  good 
reason  that  electrotherapists  themselves  have  tried  it  and 


146  PRINCIPLES   OF   OSTEOPATHY. 

found  it  wanting.  And  not  because  of  any  particularly  harm- 
ful effect  on  the  tissues  produced  by  the  current  as  such  but 
because  the  positive  results  were  unsatisfactory.  That  it  will 
be  found  equally  true  of  the  mechanical  stimulation  we  are 
thoroughly  convinced. 

We  have  finally  to  mention  a  fact  that  is  of  first  impor- 
tance and  that  is,  that  in  all  cases  where  function  is  artificial- 
ly changed  by  increase  or  decrease  there  will  be  a  recoil  in 
the  opposite  direction.  This  is  notably  true  with  respect  to 
experimental  stimulation  in  the  laboratory.  Goltz' s  experiment 
on  the  inhibitory  action  of  the  cardiac  nerves  of  the  frog  is  a 
case  in  point.  The  following  is  the  description  of  the  experi- 
ment as  given  in  the  American  Text-book  of  Physiology.  "In  a 
medium  sized  frog  the  pericardium  was  exposed  by  carefully 
cutting  a  small  window  in  the  chest  wall.  The  pulsations  of 
the  heart  could  be  seen  through  the  thin  pericardial  mem- 
brane. Goltz  now  began  to  beat  upon  the  abdomen  about 
140  times  a  minute  with  the  handle  of  a  scalpel.  The  heart 
gradually  slowed  and  at  length  stood  still  in  diastole.  Goltz 
now  ceased  the  rain  of  little  blows.  The  heart  remained  quiet 
for  a  time  and  then  began  to  beat  again,  at  first  slowly,  and 
then  more  rapidly.  Some  time  after  the  experiment  the  heart 
beat  about  Jive  strokes  in  a  minute  faster  than  before  the  experiment 
was  begun.  The  effect  cannot  be  obtained  after  section  of  the 
vagi."  The  italics  are  used  to  call  attention  to  the  fact  that 
the  final  effect  was  not  an  inhibition,  but  a  stimulation.  Some 
experimentation  has  been  and  is  being  done  at  the  present 
time  by  osteopathic  investigators  to  show  that  a  direct  effect 
can  be  produced  in  case  of  man  and  lower  animals  (rabbit) 
by  stimulation  and  inhibition  in  connection  with  the  cardiac 
nerves  and  the  splanchnics,a  proposition  to  which  assent  ha& 
already  been  given.  While  these  experiments  seem  to  sub- 
stantiate the  proposition  that  such  a  direct  action  is  possible 
it  remains  to  be  shown  that  the  effect  is  at  all  permanent  or 
advisable,  and  more  especially  to  prove  that  a  recoil  is  not  in- 
evitable or  probable.  Further  observation  of  such  experimen- 


THE  TREATMENT   OF   DISEASE.  147 

tation  is  awaited  with  interest.  What  is  true  in  those  cases 
in  which  accurate  experimentation  is  possible  is  reasonably 
true  of  all  others.  Any  swing  of  the  pendulum  past  the 
position  which  is  normal  under  the  existing  circumstances 
will  be  compensated  for  by  a  recoil  of  opposite  sign.  Note 
the  fact  that  the  organism  brooks  no  interference  with  its  function 
and  will  return  to  its  normal  activity  when  it  has  by  sudden 
force  been  disturbed  in  that  activity. 

Thus  far  reference  has  been  made  to  some  of  .the  difficul- 
ties which  beset  him  who  would  attempt  by  nerve  stimulation 
or  inhibition  to  secure  a  definite  control  over  the  functions  of 
the  organism.  Admitting  that  notwithstanding  these  diffi- 
culties there  is  still  possible  a  limited  and  temporary  control, 
it  is  necessary  to  consider  certain  objections  to  the  use  of 
those  measures,  and  also  the  conditions  where  such  treatment 
might  be  necessary  or  helpful. 

OBJECTIONS  AGAINST  ATTEMPT  AT  DIRECT  CONTROL. 

By  stimulating  or  inhibiting  a  nerve  or  other  structure 
we  interfere  with  normal  function.  It  has  before  been 
suggested  that  function  is  normal  to  structure.  Making  simply 
a  general  statement,  every  function ,  be  it  usual  or  unusual ',  is 
what  it  should  be  under  the  circumstances  of  existing  structure.  An 
increased  peripheral  resistance  to  the  blood  flow  will  cause 
an  over-active  heart.  This  latter  condition  is  normal  under  the 
circumstances.  It  must  increase  its  activity  in  order  to  keep 
up  normal  circulation.  The  attempt  to  limit  the  heart's  action 
by  inhibiting  it  is  a  distinct  hindrance  and  an  illogical  treat- 
ment. Suppose  that  the  peripheral  resistance  was  maintain- 
ed so  long  as  to  exhaust  the  heart's  action.  The  lessened 
force  resulting  is  still  normal  to  the  structural  conditions. 
The  stomach  in  discharging  its  contents  through  the  esophagus 
is  performing  a  normal  function  and  so  long  as  it  can  by  that 
method  rid  itself  of  irritant  material  vomiting  should  be  un- 
hindered. 

Note  further  that  a  stimulus  applied  to  a  failing  function 


148  PRINCIPLES   OF  OSTEOPATHY. 

is  in  many  cases  crowding  an  already  overworked  organ. 
Notice  one  of  the  foregoing  illustrations.  When  the  heart  by 
reason  of  an  imperfect  blood  supply  through  lesion  or  other- 
wise is  weakened,  the  work  it  is  performing  represents  its 
capacity  at  the  time.  If  a  stimulus  is  applied  to  the  accellera- 
tor  nerves  to  hasten  its  action,  only  an  earlier  exhaustion  will 
be  the  result.  Attention  is  called  to  the  factthattheaccellera- 
tors  like  other  motor  nerves  cause  an  increased  muscle  ac- 
tivity, i.  e.,  increase  its  tone,  its  excitability,  and  its  conduc- 
tivity, which  in  turn  depends  on  a  more  rapid  katabolism. 
Hence  in  causing  this  increase  only  a  more  rapid  exhaustion 
of  the  reserve  force  stored  in  the  heart  muscle  or  in  its  other 
centers  of  supply  is  produced.  The  same  principle  is  applic- 
able to  each  organ  in  the  body.  Its  function  is  not  decreased 
because  of  an  inherent  laziness \  but  because  its  force  has  been  lessen- 
ed through  exhaustion  of  nutritive  material. 

The  reaction  may  be  as  great  as  the  original  action. 
Leaving  the  structural  conditions  as  they  are,  a  temporary 
accellerated  peristalsis  of  the  intestine  will  be  followed  by  a 
period  of  more  lessened  bowel  activity.  Just  as  in  the  use  of 
a  cathartic  a  constantly  increasing  dose  is  necessary  to  produce 
an  action  till  finally  it  becomes  ineffective,  so  a  mechanical 
stimulus  will  be  followed  by  a  lessening  response.  A  stimu- 
lation of  the  vaso-constrictors  will  be  followed  by  a  greater  vas- 
cular dilatation.  An  inhibitory  treatment  for  pain  is  occasion- 
ally followed  by  a  return  of  the  sensory  disorder  in  greater 
intensity. 

In  many  cases  the  palliative  treatment  serves  only  to 
conceal  a  serious  condition.  Osteopaths  condemn  the  old- 
school  practice  of  giving  morphine  for  lessening  pain  and  yet 
in  numerous  instances  make  use  of  exactly  the  same  reasoning 
and  practice  with  barely  a  thought  of  the  consequences.  The 
concealment  of  a  pain  condition  from  the  patient  by  any 
treatment  without  the  removal  of  its  cause  is  a  crime  against 
the  patient,  if  the  pain  is  necessary  for  diagnosis  of  the  case.  The 


THE   TREATMENT   OF   DISEASE. 


149 


plea  that  the  patient  insists  on   it  or  that  it  gives  nature  a 

chance  for  repair  is  seldom 
a  sufficient  justification.  The 
lessening  of  a  rapid  heart 
beat  gives  often  a  sense  of 
security -entirely  unwarrant- 
ed by  the  real  state  of  that 
organ.  The  "tonic"  treat- 
ment gives  a  temporary 
sense  of  exhilaration  similar 
in  kind  if  not  in  degree  to 
that  following  moderate 
doses  of  morphine  or  alcohol. 
This  form  of  deception  is 

FIG.  8.-Theory  of  Inhibition.  ]ittle    more    justifiable     than 

any  other  and  as  often  results  disastrously. 

A  final  objection  that  is  exemplified  occasionally  is  the 
fact  that  a  treatment  habit  may  just  as  really  be  formed 
as  will  a  drug  habit.  In  both  cases  the  organism  eventually 
tends  to  rely  on  the  artificial  stimulus  instead  of  the  natural 
one  for  its  proper  functioning.  That  individual  who  requires 
frequent  treatment  to  be  kept  in  normal  "tone"  is  as  much  a 
treatment  habitue  as  is  he  who  requires  the  daily  application  of 
the  needle,  a  morphine  fiend.  And  yet  many  osteopaths 
pander  to  the  temptation  by  advertising  the  value  and  pleas- 
ure to  be  derived  from  a  "tonic"  treatment. 

But  it  would  be  incorrect  to  leave  the  impression  that 
such  attempt  at  direct  control  is  never  justified.  Experience 
seems  to  suggest  that  while  there  are  numerous  possibilities 
of  ineffectiveness  or  of  real  harm  in  such  purely  palliative 
treatment,  there  are  occasions  where  such  procedures  may  be 
a  choice  of  evils.  For  it  cannot  be  denied  that  in  many 
cases  stimulating  and  inhibitory  treatments  have  been  and  will 
continue  to  be  given  with  marked  benefit.  Note  that  it  is  not 
insisted  that  the  good  results  gotten  are  necessarily  dependent  on  nerve 
stimulation  or  inhibition.  To  this  phase  of  the  question  reference 


150  PRINCIPLES   OF   OSTEOPATHY. 

will  later  be  made.  At  present  we  shall  speak  of  those  cases 
in  which  such  treatment  is  theoretically  or  practically  de- 
manded. 

INDICATIONS  FOR  ATTEMPTS  AT  DIRECT  CONTROL. 

In  those  cases  where  a  lesion  is  not   apparent,   and 

no  other  known  cause  is  noticed  a  treatment  in  the  region  of 
innervation  is  often  seemingly  helpful.  In  occasional  cases 
the  ordinary  practitioner  will  not  be  able  to  detect  splanchnic 
or  other  lesion  affecting  the  stomach  and  yet  stomach  trouble 
exists.  Treatment  applied  in  the  lesion  region  for  such  dis- 
orders will  often  be  effective.  A  lax  condition  of  the  general 
circulatory  mechanism  is  sometimes  apparent  where  no  definite 
lesion  can  be  assigned  for  the  disorder.  A  general  spinal 
"toning  up"  is  resorted  to  with  at  least  temporary  benefit. 
An  over  active  peristalsis  is  often  checked  by  strong  pressure 
in  the  lumbar  or  lower  thoracic  region.  Pain  is  lessened  by 
treatment  over  the  structures  associated  with  the  sensory 
nerve  involved. 

It  would  seem  to  be  helpful  to  apply  a  stimulus  after  re- 
moval of  lesion  or  other  cause.  The  analogy  is  drawn  be- 
tween the  cases  of  a  stalled  horse  whose  progress  is  hindered 
by  a  stone  in  front  of  the  wheel  of  a  vehicle,  and  an  organ 
working  against  a  hindering  lesion.  In  each  case  the  pulling 
force  has  become  discouraged.  After  removal  of  the  stone  it 
may  be  helpful  to  "touch  up"  the  horse  with  a  whip,  and  like- 
wise to  "touch  up"  the  organ  through  its  nerve  mechanism. 
The  liver  is  often  directly  manipulated  by  pressure  after  the 
spinal  lesion  is  removed.  The  sluggish  kidney  will  seemingly 
respond  to  a  treatment  after  the  lumbar  lesion  is  removed. 
A  iiterine  headache  will  be  sooner  overcome  if  a  cervical  treat- 
ment is  given  following  the  adjustment  of  the  uterus  than 
would  otherwise  be  the  case. 

In  rare  cases  where  removal  of  the  cause  may  be 
impossible  or  impracticable.  In  such  case  it  will  be  a 
choice  of  risks  whether  to  leave  all  to  nature  or  to  attempt  to 


V  CF 

COLLEGE  CF  OG 


THE   TREATMENT   OF  DISEASE.  151 

bring  out  any  latent  power  of  nature  that  the  condition  itself 
fails  to  arouse.  In  an  ankylosis  of  the  spine  the  lesion  is  a 
bony  union  and  as  such  is  practically  impossible  of  removal. 
The  functions  interfered  with  thereby  may  be  aided  by  occa- 
sional treatment  of  the  spinal  regions  and  of  the  involved  or- 
gans directly;  flooding  from  the  uterus  following  parturition 
may  be  lessened  by  a  stimulus  to  the  mons  veneris  ;  intense 
nervous  or  mental  excitement  interfering  with  direct  treatment 
to  the  primary  lesion  may  be  lessened  by  pressure  applied  in 
the  sub-occipital  region;  it  may  be  necessary  to  lessen  paw, 
in  case  of  such  intensity  as  to  prevent  use  of  the  various  meth- 
ods of  diagnosis,  or  the  application  of  treatment  measures. 

In  some  cases  direct  stimulation  may  force  an  obstruc- 
tion  and  hence  be  a  factor  in  the  removal  of  a  lesion  as  well 
as  overcoming  an  effect.  Increasing  the  heart's  force  may 
overcome  a  congested  venous  or  capillary  condition.  Direct 
work  over  the  liver  may  increase  bile  secretion  and  thereby 
assist  in  removing  obstruction  to  the  gall  duct.  Direct  treat- 
ment to  muscle  tissues  may  assist  in  adjusting  the  structures 
to  which  those  tissues  are  attached. 

In  occasional  instances  it  may  be  necessary  to  resort  to 
heroic  measures  in  order  to  tide  over  the  crisis.  In  case  of 
a  sudden  heart  failure  direct  pressure  over  the  solar  plexus  or 
manipulation  in  the  accelerator  region  may  assi'st  in  prevent- 
ing collapse;  in  case,  of  hemorrhage  an  extreme  stimulus  ap- 
plied to  the  part  may  temporarily  check  the  flow;  spasmodic 
laryngitis  or  croup  may  be  prevented  from  terminating  fatally 
through  strangulation,  by  treatment  of  the  laryngeal  and  other 
structures. 

In  some  cases  it  may  be  advisable  for  the  osteopath  to 
place  himself  on  the  same  plane  with  the  old  school  physician 
and  treat  the  symytoms  as  they  arise,  for  it  is  to  be  noted 
that  a  symptom  may  in  some  cases  be  a  distinct  hindrance  to 
normal  processes  of  repair.  With  reference  to  pain,  while  it  is 
of  value  to  the  organism  in  numerous  ways  its  great  intensity 
in  some  cases  renders  it  a  distinct  disadvantage  and  inhibi- 


TCO    nO  323JJOO 
I  jjliAtOlc\  KS 

152  PRINCIPLES   OP  OSTEOPATHY. 

tion  may  become  helpful  by  lessening  the  nerve  disturbance 
thereby  giving  the  organism  a  better  opportunity  for  repair; 
an  excessively  high  temperature  becomes  a  menace  to  the  life 
of  the  individual  and  direct  treatment  for  purposes  of  lower- 
ing that  temperature  may  be  called  for;  the  rapid  waste  of 
the  fluids  of  the  body  in  certain  diarrhceic  conditions  contrib- 
utes to  an  undue  weakness  and  may  be  prevented  by  inhibi- 
tory treatment;  in  case  of  excessive  vomiting  where  no  longer 
irritant  material  is  ejected  the  nervous  disorder  permitting 
it  may  be  adjusted  by  inhibitory  treatment. 

It  will  be  noticed  that  in  most  of  the  foregoing  cases  the 
treatment  partakes  largely  of  the  nature  of  a  choice  of  evils 
and  suggests  what  it  is  necessary  to  continually  emphasize, 
that  these  measures  are  only  to  be  employed  where,  in  the 
judgment  of  the  physician,  the  primary  and  logical  treat- 
ment, i.  e.,  removal  of  cause,  is  not  immediately  possible  or 
practicable. 

Do  WE  STIMLUATE  OR  INHIBIT? 

But  if  further  analysis  is  made  of  the  above  cases  it  will 
be  found  that  the  words  stimulation  and  inhibition  are  decep- 
tive in  many  cases.  In  the  ordinary  acceptation  of  those 
terms  it  would  be  understood  that  the  function  of  the  part  dis- 
ordered was  increased  or  decreased  directly  or  through  its 
connecting  nerve.  But  let  us  see.  In  the  first  set  of  condi- 
tions referred  to  stimulation  was  employed  where  no  appar- 
ent lesion  was  present.  Emphatically  that  does  not  mean  that 
no  lesion  was  present.  In  the  application  of  a  "stimulating" 
treatment  to  the  region  of  innervation  we  are  persuaded  that 
instead  of  pure  stimulation  of  those  nerves  by  a  quick  pres- 
sure alternating  with  relaxation,  there  results  in  reality  a  re- 
moval of  distinct  impingement  upon  nerve  or  other  structures 
which  rendered  their  activity  sub-normal.  Note  a  typical 
case.  In  occasional  instances  of  constipation  no  very  distinct 
spinal  lesion  ia  apparent;  all  experience  indicates  that  a 
"stimulating"  treatment  through  the  lower  thoracic  and  lum- 


THE   TREATMENT   OF   DISEASE.  153 

bar  regions  is  more  effective  than  is  a  quiet  pressure  treat- 
ment; if  the  results  were  dependent  upon  direct  effects  pro- 
duced on  the  splanchnic  nerves  the  latter  form  of  treatment 
should  be  the  more  effective,  for  the  physiological  result  of 
stimulation  of  the  splanchnic  nerves  is  a  lessened  peristalsis. 
In  such  a  case  as  this  there  is  undoubtedly  produced  an  effect 
upon  the  involved  nerves,  but  it  is  done  indirectly,  through  the 
removal  of  pressure  conditions  in  the  spinal  region  which  were  pro- 
ducing the  existing  inhibitory  effect.  What  is  true  of  the  stimu- 
lation in  this  case  we  are  persuaded  is  true  in  the  vast  major- 
ity of  cases.  If  it  is  the  direct  stimulant  effect  on  the  nerve, 
why  will  not  titillation  of  the  skin  in  the  process  of  tickling,  or 
the  application  of  an  electric  stimulus  be  productive  of  equal- 
ly good  or  more  favorable  results? 

In  the  second  class  of  conditions  the  analogy  between 
the  horse  and  the  organ  is  far-fetched.  While  it  is  true  that 
the  horse  may  become  discouraged  there  is  nothing  to  indi- 
cate a  possibility  of  a  similar  condition  in  case  of  an  organ ; 
on  removal  of  the  lesion  the  disease  condition  itself  is  the  only 
"touching  up"  process  necessary  to  arouse  the  entire  respon- 
sive powers  of  the  organism.  When  the  removal  of  the  lesion 
is  impossible  the  so-called  stimulation  or  inhibition  that  is 
supposed  to  be  advantageous  may  perhaps  be  a  real  though 
incomplete  removal  of  a  part  of  the  lesion  condition.  Any 
breaking  up  treatment  of  the  spine  in  the  rigid  condition  of 
that  structure  opens  up  the  tissues  and  undoubtedly  frees  the 
nerve  and  vascular  mechanism  of  the  spine  sufficiently  to  ac- 
count for  the  benefit  that  results  from  the  treatment.  With 
reference  to  the  inhibition  ofpam  which  is  the  typical  example 
of  the  value  of  inhibition  as  a  therapeutic  measure,  a  few  con- 
siderations may  not  be  out  of  place.  This  proposition  is  fun- 
damental :  The  success  in  overcoming  any  pain  condition  is  in  di- 
rect proportion  to  the  amount  ofstructitral  adjustment  effected.  Given 
a  pain  condition  with  little  structural  change  present,  the  pos- 
sibility of  diminishing  that  pain  will  be  a  minimum ;  with  the 

greater  removable  structural  abnormality  associated  with  the 

11 


154  PRINCIPLES   OF   OSTEOPATHY. 

pain  will  go  the  maximum  possibility  of  pain  removal.  FOP 
instance  there  are  numerous  cases  of  pain  resulting  from  vis- 
ceral disorders.  In  these  cases  there  will  be  also  muscle  con- 
tractures  in  the  spinal  region  either  primary  or  secondary.  In 
either  case  the  pain  will  be  overcome  in  proportion  to  the  ex- 
tent to  which  the  muscular  contracture  or  other  lesion  is  di- 
minished. Reference  has  been  made  to  the  fact  that  in  ex  - 
perimental  physiology  it  is  most  difficult  to  apply  pressure 
gradually  enough  to  prevent  stimulation  not  to  speak  of  the 
possibility  of  lessening  the  nerve  action  concerned.  This  is 
possible,  that  the  nerve  action  may  be  lessened  by  a  destruc- 
tive process  such  as  is  associated  with  the  action  of  the  various 
anodynes.  It  is  possible  that  the  good  effect  from  pressure 
continuously  applied  over  the  nerve  terminals  may  result 
partly  from  this  actual  though  temporary  destruction  of  the 
nerve  terminals.  We  are  inclined  to  think  that  in  so  far  as 
the  pain  condition  is  removed  by  this  direct  nerve  pressure 
it  is  produced  by  some  such  disorganization  or  molecular  dis- 
turbance of  the  nerve  protoplasm ;  which  if  true  makes  it  at 
on  3e  apparent  that  such  treatment  is  one  of  doubtful  value. 
It  has  been  assumed  that  the  stretching  of  the  sciatic  nerve 
produces  the  lessening  of  the  pain  by  virtue  of  pressure  of 
the  nerve  sheath  upon  the  axis  cylinder  processes  throughout 
their  extent.  Physiological  experimentation  shows  that  the 
stretching  process  at  first  renders  the  nerve  protoplasm  more 
irritable;  if  long  continued  its  irritability  becomes  lessened 
or  totally  destroyed,  in  which  case  there  must  be  produced  a 
disturbance  in  the  arrangement  of  the  protoplasmic  molecules 
such  as  to  interfere  with  their  normal  relationships.  Such  an 
explanation  may  account  for  the  good  effects  that  often  follow 
the  stretching  of  the  sciatic  nerve  in  so-called  sciatic  rheuma- 
tism. The  other  explanation  is  the  more  probable,  i.  e.,  by 
the  hyper- extension  of  the  limb  tension  of  the  associated 
structures  is  removed  with  a  resulting  lessened  impingement 
upon  the  nerve  and  its  branches. 

In  summing  up  the  discussion  emphasis  is  to  be  laid  up- 


THE   TREATMENT   OP   DISEASE.  155 

on  the  fact  that  the  removal  of  lesion  or  other  cause  of  disorder 
constitutes  the  logical  treatment  for  that  disorder.  Where  a 
structure  or  organ  needs  stimulating  or  inhibiting,  it  can  be 
done  in  but  one  proper  way  and  that  an  indirect  way,  i.  e., 
the  removal  of  the  cause  that  makes  it  necessary  to  stimulate 
or  inhibit.  Hence  we  formulate  the  two  following  similar 
propositions : 

1 .  The  necessity  for  stimulation  presupposes  an  existing  inhibi- 
tion; the  removal  of  the  cause  of  that  existing  inhibition  constitutes  the 
legitimate  method  of  stimulation. 

2.  The  necessity  for  inhibition  presupposes  an  existing  stimula- 
tion ;  the  removal  of  the  cause  of  that  existing  stimulation  constitutes 
the  legitimate  method  of  inhibition. 

These  propositions  are  fundamental  and  comprehend  the 
essence  of  the  osfceopathic  view  of  the  treatment  of  disordered 
conditions  and  are  applicable  to  the  entire  field  of  disease. 

TREATMENT  OP  DISEASE  CAUSED  BY  ABUSE. 

In  discussing  the  causes  of  disease  attention  was  call- 
ed to  the  fact  that  abuse  of  an  organ  or  its  function  will  ulti- 
mately produce  a  diseased  condition  of  that  organ.  What  con- 
stitutes the  legitimate  treatment  for  such  cases?  It  is  obvious 
that  a  negative  treatment  is  undoubtedly  called  for,  i.  e., 
simple  abstinence  from  abuse.  If  stomach  disorder  be  caused 
by  continual  over-loading,lessen  the  load.  If  writer's  cramp  re- 
sult from  excessive  exercise  of  the  limited  set  of  muscles,  stop 
writing.  If  the  environmental  conditions  are  such  as  to  sub- 
ject the  individual  to  abuse  of  the  respiratory  tract,  move  out 
and  away  from  such  environment.  This  proposition  seems 
valid :  In  case  of  disease  due  only  to. abuse  and  not  associated  with 
structural  disorder,  no  positive  manipulative  treatment  is  indicated. 
Through  ages  of  false  training  men  have  become  established 
in  the  belief  that  for  every  apparent  disorder  something 
should  be  done  in  the  way  of  definite  artificial  treatment. 
Reliance  has  heretofore  been  placed  on  the  drug.  With  the 
one  who  has  learned  of  the  efficiency  of  osteopathic  measures 


156  PRINCIPLES   OP  OSTEOPATHY. 

he  assumes  a  "treatment"  is  necessary  under  the  similar  cir- 
cumstances. In  many  cases  he  is  right.  In  numerous  cases 
he  is  wrong.  In  those  cases  where  temporary  disorder  results 
from  manifest  abuse  treatment  is  unnecessary  and  perhaps 
harmful.  In  this  regard  advocates  of  any  form  of  psychic 
therapeutics  are  essentially  correct.  Let  alone  and  nature  will 
be  the  all-sufficient  factor  in  cure.  But  experience  and  reason 
both  indicate  that  there  are  limits  to  the  recuperative  power 
of  nature,  and  osteopaths  emphasize  that  in  many  cases  that 
limit  is  represented  by  a  definite  obstruction  in  the  machinery 
through  which  nature  manifests  her  curative  power.  In  such 
case  artificial  aid  is  indicated.  Note  this  fact.  Most  cases  pri- 
marily due  to  abuse  are  not  unassociated  with  structural  disturbance. 
In  many  cases  ^predisposing  lesion  is  present  which  represents 
a  factor  involving  definite  difficulty  in  nature's  reparative 
processes.  In  more  cases  secondary  lesions  will  arise  which 
add  to  the  disorder  and  constitute  new  causal  factors.  In 
both  of  these  cases  definite  manipulative  treatment  is  called 
for  and  without  question  is  advantageous.  Hence  it  is  found 
that  cases  in  which  treatment  is  not  necessary  or  helpful  are 
comparatively  rare,  and  the  osteopath  should  never  fail  to 
carefully  examine  a  condition  before  he  pronounces  it  a  case 
requiring  no  treatment  except  the  negative  one  of  abstinence. 
Will  a  patient  recover  under  osteopathic  manipulation 
when  he  refuses  or  is  unable  to  abstain  from  abuse? 
Numerous  cases  of  such  are  found.  Occupations  requiring 
life  in  adverse  circumstances  of  environment  must  be  con- 
tinued by  many  in  order  that  life  itself  may  be  supported. 
The  miner  still  must  live  in  the  mine,  the  writer  still  must 
use  his  exhausted  fingers,  the  unfortunate  must  still  use  ill- 
nourishing  food.  Can  such  recover?  In  countless  cases, 
yes.  In  any  case,  only  with  greater  difficulty.  As  illustra- 
tion may  be  cited  any  number  of  cases  of  eye  trouble  that  have 
been  successfully  treated  at  the  A.  T.  Still  Infirmary  where 
the  patient  at  the  same  time  was  taking  the  school  course 
and  was  compelled  thereby  to  abuse  his  eyes.  So  long,  how- 


THE   TREATMENT   OF  DISEASE.  157 

ever,  as  abuse  is  the  sole  factor,  which  is  only  an  occasional 
condition,  little  can  be  done  if  the  abuse  is  continued. 

On  the  other  hand,  will  a  patient  recover  if,  predispos- 
ing or  secondary  lesions  be  present,  no  manipulative  treat- 
ment be  given  and  the  patient  simply  abstains  from  abuse? 
This  is  undoubtedly  true  in  a  large  number  of  cases.  For  it 
has  already  been  shown  that  while  function  is  much  more 
markedly  self -regulative  than  in  structure  yet  nature  is  suc- 
cessful, unaided  in  many  cases,  in  overcoming  a  definite 
structural  change.  This  will  be  more  noticeably  the  case 
with  reference  to  the  lesions  which  have  arisen  as  secondary 
processes  during  the  course  of  the  abuse  than  in  those  cases 
where  a  predisposing  lesion  was  present  from  the  beginning. 
In  the  latter  case  it  is  likely  that  the  tendency  to  the  disorder 
will  not  be  overcome  and  hence  the  condition  regained  will 
be  that  of  the  organism  previous  to  the  abuse,  i.  e.,  there 
will  still  be  a  predisposition.  But  in  all  cases  where  lesion 
conditions  of  any  kind  are  present  practice  and  common 
sense  indicate  that  removal  of  lesion  and  abstinence  from 
abuse  must  go  hand  in  hand  if  most  satisfactory  results  are 
to  be  obtained. 

MISCELLANEOUS  NOTES. 

A  few  questions  of  general  interest  invariably  arise  in 
the  mind  of  the  student  with  regard  to  the  difficulty  expe- 
rienced in  overcoming  the  lesion,  the  time  required  to  effect 
a  cure,  and  the  frequency  and  length  of  treatment,  and  it 
seems  advisable  to  note  a  few  of  the  facts  which  enable  us  to 
explain  the  varying  results  obtained,  and  suggest  the  factors 
necessary  to  be  considered  in  judging  cases,  although  it  will 
be  noted  that  in  many  instances  the  judgment  of  the  physi- 
cian in  the  immediate  case  will  be  the  court  of  final  appeal. 

The  first  to  be  noted  is  an  explanation  of  the  fact  that 
lesions  are  not  immediately  removed.  Osteopathy 
has  made  its  reputation  before  the  world  perhaps  more  be- 
cause of  a  few  occasional  startling  instances  where  a  single 


158  PRINCIPLES   OP   OSTEOPATHY. 

treatment  has  overcome  a  case  of  long  standing  than  by  the 
vastly  greater  number  who  have  been  cured  only  after  long 
and  toilsome  effort  on  the  part  of  both  physician  and  pa- 
tient. The  strength  of  the  system  is  derived  from  the  latter 
class  but  it  is  most  noticeably  brought  to  the  attention  of  the 
world  by  the  former.  Why  is  it  that  all  cases  are  not  of  the 
"quick  cure"  class?  If  the  treatment  consists  in  re-arrang- 
ing the  luxated  parts  why  not  do  so  immediately  as  does  the 
engineer  with  his  engine?  There  are  several  facts  which 
serve  to  explain  this  situation.  In  the  first  place  the  man- 
machine  does  not  quickly  change  its  parts  under  normal  con- 
ditions. While  there  is  continual  change  it  is  a  process  requir- 
ing time.  It  is  no  less  true  in  abnormal  states.  The  vitaliz- 
ing force  carries  forward  its  work  of  repair  certainly  but 
slowly.  In  this  there  is  a  marked  distinction  from  the  man- 
made  machine.  Again,  it  is  necessary  to  remember  the  con- 
ditions presenting  themselves  in  case  of  a  lesion.  When 
first  produced  the  tendency  is  to  draw  back  into  line  or  other- 
wise overcome  the  abnormal  part  by  the  inherent  power  of 
adjustment.  In  many  cases  nature  is  successful  in  this  ef- 
fort. In  occasional  cases  she  is  unable  to  accomplish  the  re- 
sult and  in  such  we  have  the  field  of  operation  for  the  physi- 
cian. But  note  the  second  effort  on  the  part  of  nature.  Fail- 
ing in  applying  adjustment  by  drawing  back  to  normal  align- 
ment the  perverted  structure  she  applies  it  in  the  way  of 
adjusting  the  surrounding  structure  in  position  and  form,  to 
the  new  abnormal  one.  This  becomes  especially  noticeable 
in  case  of  a  hip  dislocation  where  it  is  known  that  the  su- 
perior hip  muscles  have  permanently  shortened  while  the 
inferior  ones  have  correspondingly  lengthened.  A  general 
re -arrangement  of  parts  will  also  take  place  in  case  of  a 
vertebral  or  a  rib  lesion,  so  that  in  numerous  cases  the  new 
condition  becomes  finally  a  normal  one  in  the  sense  at  least 
of  producing  no  marked  abnormal  functioning;  not  normal, 
however,  in  the  sense  of  the  new  arrangement  being  as  sub- 
stantial as  the  original.  In  a  certain  percentage  of  such 


THE  TREATMENT   OF   DISEASE.  159 

cases  there  will  still  be  a  partial  failure  to  adjust  and  a  real 
and  chronic  lesion  prevails.  It  is  necessary  then  for  the 
physician  to  either  overcome  this  partial  adjustment  or  to 
give  enough  of  aid  by  manipulation  to  permit  a  full  adjust- 
ment to  the  new  condition.  In  either  case  it  is  obvious  that 
some  considerable  time  will  be  necessary.  Of  course  the 
above  considerations  have  especial  reference  to  chronic 
lesions.  In  acute  cases  much  less  time  and  fewer  treatments 
will  be  required. 

Again,  in  many  cases  the  lesion  is  not  entirely  re- 
moved, that  is.  in  the  sense  of  securing  a  complete  return  to 
normal  of  the  perverted  part.  This  is  less  often  true  when 
we  consider  the  other  side  of  the  lesion  idea,  the  perverted 
function.  For  while  in  many  cases  the  structure  may  not  be 
entirely  overcome,  in  most  of  these  the  perverted  function  will 
have  disappeared.  Note  the  fact  that  as  a  general  rule  the 
function  will  have  become  normal  before  the  structural  parts  will  have 
been  entirely  overcome.  This  fact  depends  on  the  power  of 
adaptability  possessed  by  the  organism.  It  is  able  to  produce 
normal  function  with  tools  that  are  not  as  yet  ideal.  From 
this  fact  we  see  one  explanation  of  the  lesion's  incomplete  re- 
duction. The  patient,  as  soon  as  he  feels  normal  and  sees  no 
further  symptoms  of  any  disorder,  will  assume  that  his  cure 
is  complete;  and  for  the  time  and  perhaps  permanently  that 
is  true.  Hence  he  will  refuse  longer  to  pursue  the  treatment. 
In  all  such  cases  emphasis  should  be  laid  on  the  fact  that  the 
incompleted  structural  reduction  will  remain  a  weakened  con- 
dition and  hence  be  a  continuous  menace  to  the  health  of  the 
individual  either  in  causing  a  return  of  the  original  disorder 
or  of  another  that  is  possible  from  the  same  lesion.  Further, 
owing  to  the  partial  adjustment  that  has  taken  place  in  the 
chronic  case  the  strength  of  the  new  articulation  or  adhesions 
may  be  such  as  to  defy  the  most  persistent  treatment.  We 
are  persuaded,  however,  that  in  the  great  majority  of  cases 
the  original  normal  condition  of  structure  as  well  as  function 


160  PRINCIPLES   OF  OSTEOPATHY. 

may  be  restored  provided  opportunity'in  the  way   of  time  is 
secured. 

With  regard  to  the  frequency  of  treatment, only  gen- 
eral rules  may  be  given.  At  the  risk  of  becoming  tiresome, 
the  statement  must  be  emphasized  that  it  is  not  the  physician 
but  nature  that  heals.  If  it  were  the  former  one  might  be 
justified  in  frequent  attempts  to  adjust  a  part.  Since  it  is  the 
latter,  time  must  be  permitted  in  order  that  the  gradual  pro- 
cess of  repair  should  take  place.  It  must  be  remembered  that 
a  condition  which  is  such  as  to  preclude  immediate  adjust- 
ment must  be  one  in  which  a  process  of  reverse  growth 
must  take  place  before  the  part  can  be  restored  to  its  original 
position.  It  will  be  a  "growing  back"  in  real  truth  and  growth 
requires  both  time  and  quiet.  If  a  beginning  can  be  made 
in  reduction  at  the  first  treatment  one  should  be  satisfied; 
then  allowing  sufficient  time  to  elapse  for  adjustment  to  the 
new  conditions  that  have  been  produced  the  process  of  repair 
and  restoration  will  be  carried  forward  with  sufficient  rapidity. 
In  general  a  frequency  sufficient  to  compel  a  continuous  sore- 
ness throughout  the  entire  interval  is  usually  too  great.  In 
chronic  diseases  the  average  case  will  prosper  most  satisfac- 
torily with  treatment  applied  two  or  three  times  per  week.  But 
each  case  must  be  a  study  in  this  sense  as  in  others.  In  some 
cases  oftener  and  in  many  cases  a  less  frequency  of  treat- 
ment will  be  found  most  satisfactory.  For  instance,  the  "Old 
Doctor"  has  always  insisted — and  younger  practitioners  are 
learning  slowly  that  he  is  right — that  the  ordinary  case  of 
asthma  should  not  be  treated  oftener  than  once  per  week  or 
ten  days.  On  the  other  hand  actite  conditions  require  more 
frequent  attention.  In  such  the  changes  are  much  more 
rapid  both  with  respect  to  repair  and  to  the  pathological  states 
that  are  produced.  Further,  owing  to  the  latter  fact  there  are 
continually  arising  secondary  lesions  and  other  causes  of  dis- 
order which  must  have  attention.  An  acute  case  will  usually 
need  treatment  one  or  more  times  per  day  during  the  more 
critical  periods. 


THE  TREATMENT   OF   DISEASE.  161 

The  considerations  in  the  above  paragraph  hold  in  part 
in  regard  to  the  length  of  the  treatment.  The  young 
osteopath  invariably  will  give  more  time  to  an  individual  treat- 
ment than  will  an  older  practitioner.  It  is  characteristic  of 
Dr.  Still  himself,  that  he  "treats  a  case  and  goes,"  and  his 
success  is  no  less  remarkable  than  the  brevity  of  his  treat- 
ment. There  is  such  a  thing  as  drawing  upon  the  vitality  of 
the  patient  by  a  too  lengthy  treatment.  It  is  not  likely  a  long 
treatment  will  be  given  except  by  him  who  gives  a  general 
rather  than  a  specific  one.  For  it  takes  but  a  few  moments 
to  produce  sufficient  irritation  of  a  local  part  to  cause  serious 
and  successful  protest  on  the  part  of  the  patient.  Where  the 
body  is  treated  as  the  masseur  treats  much  time  is  required, 
but  osteopaths  are  not  masseurs.  Cases  are  met  with  occasion- 
ally where,  owing  on  the  one  hand  to  lack  of  skill  on  the  part 
of  the  practitioner  and  on  the  other  to  an  extreme  tissue  ten- 
derness of  the  patient,  some  preliminary  treatment  may  be 
necessary  before  specific  work  can  be  given.  In  such  cases 
time  may  be  used  to  good  advantage  in  somewhat  prolonging 
the  treatment.  In  nervous  individuals  any  indication  of  hurry 
on  the  part  of  the  practitioner  will  react  unfavorably  on  the 
patient. 

With  reference  to  the  rapidity  of  movement  a  caution 
is  necessary.  In  dealing  with  all  cases,  whether  primarily  a 
bony  lesion  or  other  tissue,  quick  movements  are  not  advan- 
tageous with  but  a  few  possible  exceptions.  A  quick  move- 
ment will  usually  act  as  a  stimulus  to  an  already  hyper-sen- 
sitive tissue.  Hence  the  tissue  is  made  to  "set"  against  the 
effort  to  move  it.  Muscle  and  other  tissues  which  are  directly 
worked  upon  in  treatment  are  structures  which  under  all  con- 
ditions change  their  shape  and  condition  only  gradually.  The 
tissue  can  be  led  but  only  with  difficulty  and  with  much  possi- 
ble harm  will  it  be  driven  to  its  normal  relationships. 

There  is  a  possibility  of  harm  in  the  treatment  by 
manipulation.  The  statement  is  repeatedly  made  that  "if 
osteopathy  does  you  no  good  it  will  do  you  no  harm."  The 


162  PRINCIPLES   OF   OSTEOPATHY. 

statement  is  interesting  in  that  it  is  more  or  less  untrue. 
Osteopathic  manipulation  properly  applied  will  not  be  likely  to 
result  in  danger  but  in  the  hands  of  an  individual  unacquaint- 
ed with  the  laws  of  leverage  and  the  arrangements  of  the 
levers  which  he  uses  in  most  movements,  there  isjxmch  pos- 
sibility of  harm.  While  it  is  not  true  that  the  force  sufficient  to 
reduce  a  lesion  is  sufficient  to  prodiice  one,  yet  there  is  enough  of 
truth  in  it  to  be  worthy  of  notice.  The  harm  may  result  be- 
cause of  the  intensity  of  the  application.  The  intensity  may 
be  either  in  the  abruptness  or  in  the  absolute  amount  of  force 
used.  There  are  certain  leverages  in  the  body  by  which  a, 
sufficient  force  may  be  applied  to  rupture  the  strongest  liga- 
ment, while  a  force  not  so  great  but  suddenly  applied  may 
easily  produce  serious  injury.  The  harm  may  result  because 
the  treatment  is  too  prolonged.  In  such  a  case  the  tissue  either 
becomes  exhausted  or  what  is  more  common,  over-irritated, 
with  a  resulting  congested  or  even  inflamed  local  area.  In 
the  same  way  irritation  may  follow  too  frequent  treatment,  in 
which  time  for  repair  is  not  given.  Under  such  circumstances 
there  is  little  possibility  of  producing  satisfactory  results  and 
much  chance  of  "causing  further  disorder. 

We  do  not  speak  thus  at  length  on  the  possibility  of  harm 
from  treatment  wrongly  applied  simply  because  of  theoretical 
reasons.  Sufficient  evidence  is  brought  forward  to  show  that 
disorder  has  resulted.  With  ordinary  care  and  average  judg- 
ment the  treatment  is  entirely  harmless  but  where  those  quali- 
ties are  lacking  it  may  not  be  so.  In  any  case  it  would  not 
be  a  difficult  matter  to  show  that  while  there  may  be  some 
dar  associated  with  the  administration  of  osteopathic  treat- 
me  ;  infinitely  more  safe  than  that  of  drugging. 

*  reference  to  the  method  of  the  movement  that  may  be 
er  'ed  it  is  necessary  to  emphasize  that  probably  no  two 
p  ,itioners  who  have  been  long  in  the  field  will  execute  a 
particular  treatment  in  exactly  the  same  way.  There  are  a 
large  number  of  methods  in  the  employment  of  the  same 
principles  of  adjustment  each  of  which  may,  under  certain  cir  • 


THE   TREATMENT   OF  DISEASE.  163 

cumstances,  present  its  own  advantages.  Individuals  differ 
in  the  ease  with  which  a  movement  can  be  executed.  .  Hence 
it  is  illogical  for  a  teacher  to  insist  that  a  method  must  be 
employed  because  it  is  the  correct  one.  It  is  not  necessarily 
so.  The  patients  themselves  differ  quite  markedly  in  refer- 
ence to  the  readiness  with  which  they  yield  to  particular  treat- 
ment and  it  will  be  found  by  experience  that  what  is  perfect- 
ly appropriate  in  one  individual  will  not  be  satisfactory  in 
another  although  the  lesion  may  to  all  appearances  be  the 
same  in  each  case.  True,  in  all  movements  account  must  be 
taken  of  the  leverage  employed ;  the  physician  must  know 
the  situation  of  articulation,  the  attachments  of  muscles  and 
the  like.  But  he  can  only  know  these  as  they  exist  in  the 
average  case.  Every  new  case  will  present  new  conditions 
and  will  require  at  least  slight  differences  in  the  application 
of  treatment.  Hence  in  a  later  section  discussion  is  given 
to  a  few  common  movements  that  are  in  general  use  merely 
to  emphasize  and  illustrate  the  principles  that  underlie  every 
adjustment  that  is  effective.  The  mere  imitation  of  any 
physician's  peculiar  methods  will  always  be  unsatisfactory. 
Understand  the  forces  it  is  necessary  to  use,  determine  in  each 
case  through  what  parts  those  forces  may  be  applied,  then 
adapt  the  method  to  the  circumstances  of  the  case.  By  fol- 
lowing such  a  plan  the  student  becomes  a  man  of  emergencies 
and  learns  to  use  his  mental  powers  on  each  individual  case 
instead  of  yielding  to  the  pernicious  habit  of.  passing  each  of 
his  cases  through  the  routine  of  an  unvarying  set  of  manipu- 
lations. 


164  PRINCIPLES   OF  OSTEOPATHY. 


CHAPTER  IX. 


COMPARISON  WITH  OTHER  SYSTEMS. 

In  the  foregoing  chapters  considerations  in  general  form 
have  been  given  to  the  outlines  of  the  osteopathic  philosophy, 
suggesting  the  application  of  the  latter  to  the  etiology,  diag- 
nosis, and  treatment  of  disease.  In  the  present  chapter  the 
description  of  the  same  picture  will  be  continued  by  the 
method  of  contrast,  attempting,  in  suggesting  the  salient 
points  in  the  other  systems,  to  show  the  indentity  in  concept 
between  all  other  schools,  and  the  distinct  and  fundamental 
difference  between  them  and  the  osteopathic  system.  In 
making  the  comparison  it  will  be  necessary  to  refer  somewhat 
in  detail  to  the  principles  and  methods  associated  with  the 
other  various  systems.  The  items  of  information  have  been 
derived  from  various  sources,  all  of  which  are  authoritative. 
We  shall  discuss  in  order  the  following  more  or  less  distinct 
systems:  drug  therapy,  electrotherapy,  hydrotherapy, 
psychotherapy,  and  mechanotherapy. 

DRUG  THERAPY. 

Throughout  all  ages  men  have  relied  quite  largely  upon 
the  internal  administration  of  other  than  food  materials  for 
hope  of  alleviating  their  physical  disabilities.  Whether  the 
drug  was  used  as  a  distinct  combatant  of  -the  disease  entity 
that  was  formerly  believed  to  exist,  whether  it  was  given  for 
a  direct  chemical  effect  on  the  body  tissues,  or  whether  given  as 
&  placebo,  it  has  held  patient  and  physician  in  its  thrall 
throughout  the  centuries.  Until  comparatively  recent  times 
little  attempt  was  made  to  show  any  relation  between  the  na- 
ture of  the  medicine  and  the  effect  on  the  disorder,  all  sub- 
stances in  the  pharmacopeia  holding  their  position  by  virtue  of 
the  fact  that  observation  of  their  effects  on  the  organism  seemed 
to  suggest  a  curative  value.  That  the  observation  was  usually 


COMPARISON  WITH   OTHER   SYSTEMS.  165 

false  is  indicated  by  the  brevity  of  life  of  each  individual  drug- 
— the  specific  of  one  decade  becoming  a  discarded  relic  in  the 
next,  a  condition  as  true  today  as  ever  in  the  history  of  medi- 
cine. That  the  empirical  method  was  practically  the  only 
one  used  in  the  past  is  evident  and  that  it  still  is  largely 
employed  is  equally  true.  Dr.  T.  Lauder  Brunton  is  un- 
doubtedly an  authority  on  the  giving  of  drugs  hence  no  ob- 
jection should  be  recorded  against  accepting  his  statement  as 
representative  of  the  general  profession.  In  hia  work  on 
Lectures  on  the  Action  of  Medicines,  published  in  1899,  these 
words  are  found  in  reference  to  the  use  of  alcohol  in  certain 
conditions:  "The  rule  for  the  administration  of  alcohol  is  a 
very  simple  one.  It  is  to  sit  by  the  side  of  your  patient  for 
a  while  and  watch  him  after  the  administration  of  a  dose  of 
alcohol,  and  if  you  find  that  the  alcohol  brings  back  the 
various  functions  nearer  to  normal,  then  it  is  doing  good ;  if 
the  functions  of  the  organs  diverge  further  from  the  normal 
after  the  administration  of  alcohol,  then  it  is  doing  harm" 
(p.  329).  But  it  must  not  be  thought  that  at  the  present  time 
nothing  is  being  done  by  the  advocates  of  the  drug  in  the  way 
of  attempting  to  put  the  system  on  a  scientific  basis.  Never 
in  the  history  of  medicine  has  so  much  attention  been  given 
to  the  investigation  into  the  nature  of  the  effects  produced  by 
the  various  drugs  upon  body  tissues.  Never  has  the  study  of 
the  chemical  conditions  of  the  body  been  so  intense  as  at  the 
present  time,  in  the  hope  that  by  determining  the  chemical 
nature  of  body  tissues  in  health  and  disease  chemical  sub- 
stances could  be  obtained  which  would  in  a  chemical  way 
modify  the  body  conditions.  The  study  is  primarily  for  the 
purpose  of  determining  how,  through  a  chemical  medium,  a  function 
may  be  modified.  The  question  demands  an  answer  and  the 
very  fact  that  it  is  asked  suggests  that  the  old  school  investi- 
gators have  an  approximately  correct  conception  of  the  nature 
of  disease,  i.  e.,  perverted  function.  Unfortunately  they  have 
not  yet  been  able  to  grasp  the  fact  that  function  can  only  be 


166  PRINCIPLES   OF   OSTEOPATHY. 

modified  through  the  structure   that  is  associated   with   the 
function. 

In  the  present  stage  of  drug  practice  several  specific  pur- 
poses are  kept  in  view.  These  various  purposes  will  be  briefly 
discussed. 

Drugs  are  given  for  their  stimulant  effect.  In  those 
cases  where  the  activity  of  an  organ  is  below  par  some  drug 
is  given  which  is  believed  to  have  a  tendency  to  increase  that 
activity.  In  certain  nervous  disorders  strychnine  is  given,  for 
its  effect  is  known  to  be  exerted  upon  the  nerve  centers  there- 
by increasing  the  facility  of  discharge;  digitalis  is  in  very 
common  use  as  a  cardiac  stimulant  and  exercises  its  influence 
upon  the  heart  mechanism  directly;  morphine  in  small  doses 
gives  a  peculiar  sense  of  general  well-being  and  as  such  ex- 
ercises a  stimulant  influence  upon  the  nervous  system;  the 
numerous  bitters  used  for  purposes  of  increasing  the  appetite 
are  further  examples.  It  is  to  be  noted  in  this  connection  that 
while  the  drug  in  one  sense  acts  upon  the  tissue,  it  is  the  re- 
action of  the  tissue  upon  the  drug  that  produces  whatever 
good  result  may  follow.  The  tissue  exerts  its  excretory  and 
other  protective  powers  in  order  to  rid  itself  of  the  presence 
of  the  irritant  material,  and  in  so  increasing  its  activity  its 
function  may  be  temporarily  normalized. 

A  second  effect  produced  by  the  drug  is  that  of  the  seda- 
tive. Any  drug  which  produces  a  lessening  of  activity  is 
spoken  of  as  possessing  sedative  properties.  Opium  with  its 
alkaloidal  extracts  is  the  typical  example;  while  in  most  cases 
it  will  produce  a  slight  stimulant  action,  it  is  most  used  for 
purposes  of  deadening  pain.  Its  principal  effect  lies  in  render- 
ing the  cells  of  conscious  sensation  less  responsive  to  incom- 
ing stimuli.  Hence,  while  the  irritant  causing  the  pain 
is  still  present  the  pain  itself  may  not  be  felt  because  of  the 
lessened  irritability  of  the  higher  centers;  cocain  lessens  the 
over-activity  of  the  spinal  cord  and  of  the  peripheral  nervous 
system  by  producing  a  lessened  irritability ;  aconite  is  a  de- 
pressant of  the  heart  and  hence  is  used  in  cases  of  extreme 


COMPARISON   WITH   OTHER   SYSTEMS.  167 

activity  of  that  organ ;  various  astringents  are  given  which, 
acting  upon  the  mucous  membrane  of  the  intestinal  canal, 
lessen  its  peristalsis. 

A  third  function  of  the  drug  is  that  of  neutralization. 
A  simple  illustration  of  this  use  is  the  household  remedy  for 
sour  stomach,  ordinary  soda;  formerly,  the  salts  of  salicylic 
acid  were  given  in  cases  of  rheumatism  on  the  assumption  that 
they  hastened  absorption  of  the  deposits  by  neutralizing  them; 
at  the  present  time  the  medical  fraternity  is  enthusiastic  over 
the  use  of  various  serums  which  are  assumed  to  have  a  neu- 
tralizing effect  upon  the  toxins  generated  in  the  body  by  bac- 
terial action. 

Substitution  constitutes  another  of  the  purposes  in 
drug  giving.  It  has  long  been  known  that  in  anemia  there  is1 
a  poverty  of  red  blood  corpuscles  and  of  haemoglobin  believed 
to  be  due  to  a  lack  of  iron.  Hence  arose  the  practice  of  ad- 
ministering inorganic  iron  compounds  with  the  idea  that  this 
material  could  be  directly  substituted.  The  view  has  of  late 
years  been  discarded  since  it  has  been  demonstrated  that 
practically  none  of  the  iron  thus  administered  is  assimilated, 
and  while  at  the  present  time  it  is  still  administered  its  sup- 
posed good  effects  are  explained  from  its  stimulant  action  on 
assimilation  processes;  in  the  case  of  administration  of  the 
organic  extracts  from  various  of  the  ductless  glands  ®l  the  body 
we  have  other  illustrations  of  the  substitution  idea.  For  some 
time  it  has  been  known  that  the  absence,  congenital  or  other- 
wise, of  the  thyroid  gland  results  in  a  dwarfing  of  body  and 
mind,  and  it  has  further  been  found  that  when  these  glands 
from  other  animals  or  extracts  from  the  gland  were  given  to 
the  individual  as  a  part  of  his  food  the  condition  was  often 
partially  or  completely  overcome.  In  such  a  case  the  ma- 
terial secreted  by  the  gland  of  a  lower  animal  constituted  the 
substitution.  This  however  partakes  more  largely  of  a 
dietetic  than  a  drug  treatment,  for  the  material  is  already  or- 
ganic and  in  such  a  form  may  be  assimilated  in  the  same 
manner  as  is  food  material. 


168  PRINCIPLES   OF  OSTEOPATHY. 

A  further  action  that  certain  drugs  were  supposed  to  ex- 
ert was  that  of  a  germicide.  With  the  comparatively  rapid 
rise  and  almost  universal  acceptance  of  the  germ  theory  of 
disease  the  medical  profession  arrived  speedily  at  the  con- 
clusion that  the  problem  of  overcoming  disease  was  solved. 
Since  the  bacterium  was  the  cause  of  most  disease  conditions 
the  only  requisite  for  preventing  and  curing  the  disease  was 
the  drug  or  other  means  which  would  annihilate  the  micro- 
organism. Hence  in  the  laboratory,  experiments  were  car- 
ried on  to  determine  what  particular  chemical  substance 
would  destroy  or  render  inactive  each  specific  micro-organ- 
ism. Unfortunately  it  was  soon  found  that  owing  to  the  ex- 
treme tenacity  of  life  manifested  by  the  average  bacterium, 
any  drug  sufficient  to  destroy  its  life  was  more  than  sufficient  when 
administered  internally  to  destroy  the  body  cells.  Hence  the 
present  use  of  germicides  and  antiseptics  is  largely  limited  to 
external  administration  in  the  form  of  sprays  and  antiseptic 
washes. 

Practically  all  effects  of  the  drug  may  be  classified  un- 
der the  above  five  divisions.  The  question  arises,  are  the  re- 
sults real  and  satisfactory.  It  is  not  denied  that  the  admin- 
istration of  the  drug  is  sometimes  effective  and  in  numerous 
cases  seems  to  temporarily  relieve.  There  is  no  question  that 
digitalis  will  usually  stimulate  the  heart's  action ;  that  mor- 
phine will  often  temporarily  lessen  pain;  that  fairly  good 
evidence  is  presented  that  the  diphtheria  antitoxin  may  lessen 
the  mortality  rate;  or  that  other  drugs  may  sometimes  be  of 
some  value.  The  question  is,  does  the  good  resulting  from  their 
use  exceed  the  harm?  All  experience  goes  to  show  that  the 
harm  is  in  excess  and  the  better  class  of  physicians  of  all 
schools  are  beginning  to  realize  that  fact.  A  few  of  the  ob- 
jections to  the  use  of  the  drug,  suggesting  how  the  harm  is 
likely  to  result,  may  not  be  out  of  place. 

With  the  possible  exception  of  the  germicide  every  drug 
given  is  for  the  purpose  of  combatting  effects  and  practi- 
cally ignoring  the  cause.  A  cholagogue  is  given  to  stimulate 
the  liver  functions.  In  doing  so  the  physician  recognizes 


COMPARISON   WITH   OTHER   SYSTEMS.  169 

only  the  torpid  liver,,  i.  e.,  the  effect;    the  opiate  lessens  the 
consciousness  of  pain  but  the  cause  of  that  pain  still  persists. 

An  irritant  drug  given  to  stimulate  an  organ  but  adds 
to  the  burden.  A  renal  stimulant  causes  double  work  on 
the  part  of  the  kidney ;  that  organ  being  already  overworked 
with  reference  to  its  nutritive  condition  must,  in  addition  to 
throwing  off  the  toxic  material  from  normal  katabolic  activity, 
eliminate  also  the  drug  which  has  passed  into  the  vascular 
system. 

There  is  always  danger  from  a  possible  cumulative  ef- 
fect. In  the  constant  use  of  digitalis  as  a  heart  stimulant  the 
time  will  usually  come  when  the  ordinary  dose  instead  of  pro- 
ducing its  usual  stimulant  effect  will  bring  on  a  state  of  collapse 
with  a  possible  fatal  termination.  The  old  school  authorities 
recognize  such  to  be  the  case  although  the  explanation  is  not 
forthcoming. 

If  it  were  possible  to  apply  a  remedy  directly  to  the  tis- 
sue that  needs  it  without  bringing  it  in  contact  with  other  or- 
gans not  involved  in  disorder  there  would  be  less  objection 
to  the  use  of  drugging.  But  in  case  of  most  of  the  organs  the 
only  ready  channel  through  which  the  tissues  may  be  reached 
is  the  circulatory  system,  and  whether  the  drug  be  injected 
directly  into  that  system  or  be  taken  by  absorption  from  the 
alimentary  canal  all  parts  of  the  body  must  of  necessity  be 
contaminated  with  the  drug.  Such  being  the  case  it  is  not 
difficult  to  understand  why  other  parts  of  the  body  become 
poisoned  even  though  the  diseased  organ  may  have  been 
benefitted.  It  is  notoriously  true  that  the  stomach  of  the  con- 
stant drug  taker  is  in  a  continual  state  of  disorder  and  simply 
because  that  viscus  has  been  converted  into  a  receptacle  for 
material  never  designed  to  enter  it. 

One  of  the  most  severe  indictments  of  the  drug  system 
lies  in  the  fact  that  there  is  always  a  possibility  of  habit  for- 
mation. While  this  is  especially  true  of  a  few  drugs,  such 
as  alcohol  and  morphine,  there  is  no  drug  which  is  exempt  from 

the  possibility.     Thus  Crothers  in   his  work  on   "Morphinism 

12  / 


170  PRINCIPLES   OF   OSTEOPATHY. 

and  Narcomania  from  other  Drugs  "enumerates  a  whole  series 
in  which  observation  shows  the  possibility  and  probability  of 
the  habit  formation.  Morphine,  cocain,  chloral,  chloroform, 
tobacco  poisons,  ether,  arsenic,  quinine,  and  numerous  others 
are  named.  That  the  drug  addiction  has  gained  an  extreme 
hold  upon  the  American  people  is  indicated  from  the  fact  that 
one  individual  in  every  six  hundred  is  permanently  addicted  to 
the  use  of  morphine.  When  we  stop  to  consider  the  dozen  or 
other  drugs  in  almost  as  common  use  the  picture  becomes  ap- 
palling. And  when  the  fact  is  understood  that  the  effects  from 
the  use  of  morphine,  cocain,  and  several  others  are  equally 
as  disastrous  to  the  individual  and  to  the  nation  as  is  alcohol, 
it  would  seem  that  the  time  is  ripe  for  including  in  the  tem- 
perance crusade  evidence  and  anathema  against  the  use  of 
drugs.  In  this  connection  the  statement  of  Dr.  A.  P.  Grinnell 
in  a  late  issue  of  the  Medico-Legal  Journal  is  suggestive : 
"Sooner  or  later  the  reformers  of  the  world  have  got  to  divert 
some  of  their  feverish  antipathy  to  alcoholic  stimulants  and 
consider  calmly  and  intelligently  the  drug  evil.  The  deleteri- 
ous influence  on  the  individual  of  all  forms  of  drug  addiction 
and  the  consequent  effect  on  society  and  all  relations  of  man- 
kind, make  its  considerations  in  its  sociologic  and  criminal 
aspects  of  paramount  importance.  The  courts  have  never 
given  much  judicial  importance  to  drug  habits,  but  widespread 
development  of  drug  addiction  must  surely,  sooner  or  later, 
bring  the  matter  into  greater  legal  prominence."  In  connec- 
tion further  with  the  fact  of  habit  formation,  one  of  the  most 
prominent  medical  journals  {American  Medicine)  has  this  to 
say  in  a  recent  issue:  "In  the  'American  Journal  of  Phar- 
macy' for  November,  1902,  is  the  report  by  Mr.  Hynsori, 
chairman  of  the  committee  appointed  by  the  American  Phar- 
maceutical Association  to  investigate  the  question  of  the  ac- 
quirement of  the  drug  habit.  This  report,  while  it  is  written 
from  the  standpoint  of  the  pharmacist,  reveals  a  state  of  af- 
fairs so  truly  appalling  that  it  merits  the  consideration  of 
every  physician,  indeed  of  every  person  interested  in  the  wel- 


COMPARISON  WITH   OTHER   SYSTEMS.  171 

fare  of  society.  As  perhaps  the  moat  accurate  means  of  de- 
termining the  question  of  the  increase  in  the  drug  habit  in  the 
last  few  years,  the  committee  gives  the  statistics  concerning 
the  importation  of  two  plants  most  commonly  employed  fop 
this  purpose — namely,  opium  and  cocaine.  Since  1898  the 
population  of  the  United  States  has  increased  ten  per  cent. ; 
the  amount  of  opium  imported,  however,  has  increased  to  the 
startling  extent  of  Jive  himdred  per  cent.,  and  this  despite  the 
fact  that  it  is  less  frequently  used  by  physicians  than  in  years 
past.  The  importation  of  opium  for  1902  amounts  to  the  as- 
tounding sum  of  712,000  pounds;  and  this  is  exclusive  of  more 
than  a  ton  of  morphine.  This  increase  in  the  importation  of 
opium  is  paralleled  in  the  case  of  cocaine,  the  quantity  of 
that  alkaloid  brought  into  the  country  in  the  year  covered  by 
the  report  being  three  times  as  large  as  the  importation  of 
1898.  As  the  committee  points  out,  it  is  impossible  that  there 
should  have  been  any  such  enormous  increase  in  the  legiti- 
mate demand  for  the  drug.  Indeed,  it  would  seem  probable 
that  the  administration  by  physicians,  certainly  of  opium  and 
probably  also  of  cocaine,  has  diminished  rather  than  in- 
creased, and  it  is  thus  safe  to  conclude  that  practically  all  of 
this  supernormal  demand  is  by  drug  'fiends.'  From  responses 
to  letters  addressed  to  a  number  of  pharmacists  and  physi- 
cians in  various  cities  and  towns  in  the  East,  the  committee 
concludes  that  in  the  eastern  part  of  the  United  States  out  of 
every  one  thousand  inhabitants  about  three  are  addicted  to 
the  use  of  some  drug  other  than  alcohol.  The  condition  of 
affairs  among  certain  classes  is  almost  inconceivable;  thus 
one  of  our  correspondents,  whose  business  is  in  the  Tender- 
loin district  of  New  York  is  personally  acquainted  with  two 
hundred  opium  habitues,  while  the  police  officers  assert  that 
cocaine  adulterated  with  acetanilid  is  peddled  from  door  to 
door  as  an  ordinary  necessity  of  life.  Such  a  condition  of 
affairs  is  so  threatening  to  the  very  existence  of  society  that 
its  causes  cannot  be  too  thoroughly  investigated  in  order  to 
discover  a  proper  remedy." 


172  PRINCIPLES   OP   OSTEOPATHY. 

A  writer  in  another  journal  {Medical  News)  in  discussing 
the  rapid  inroads  patent  medicines  are  making  upon  the 
health  and  finances  of  the  American  people  has  the  following 
to  say:  "As  a  nation  largely  neurotic — both  ancestral  and 
acquired — we  offer  an  inviting  field  to  venders  of  such  wares, 
who  ply  their  trade  with  a  vigor  worthy  a  better  cause,  and 
with  results  of  which  we  must  make  note  if  we  would  conserve 
the  best  interest  of  many  whose  well-being  is  given  to  our 
care.  It  goes  without  saying  that  the  larger,  by  far,  number 
of  the  many  nostrums — nervines,  antineuralgic  pills,  powders, 
tablets,  and  liquids — so  much  heralded  and  lauded  for  relief 
of  pain  and  nervous  unrest,  have  morphine  as  their  active 
part.  And  this  'part*  in  some  is  not  small.  In  one,  largely 
advertised,  there  is  one-eighth  grain  in  each  teaspoonful. 
The  risk  of  morphinism,  in  certain  persons,  from  that  amount 
is  large;  in  fact,  a  smaller,  in  a  highly  nervous  patient  on 
whom  it  acts  kindly,  will  create  the  disease.  A  ten-years' 
case  of  morphinism,  under  my  care,  seven  years  ago,  had  its 
rise  in  a  one-sixteenth  grain  daily  dose.  Even  larger  risk  of 
inebriety  obtains  in  using  the  various  nostrums  containing 
cocain,  so  much  lauded  for  the  relief  of  coryza  andother  nasal 
ills.  In  the  form  of  catarrh  snuffs  and  solutions,  its  power 
for  harm  is  far  greater  than  when  taken  by  mouth ;  in  fact  it 
ranks  almost — or  quite — with  its  subdermic  effect,  by  virtue 
of  the  highly  absorptive  nasal  mucous  membrane,  and  its 
nearness  to  the  brain,  making  its  seductive  power  and  ill 
effect  on  mental  health  especially  prompt  and  pernicious.  One 
of  these  nostrums  contains  i^j  per  cent,  cocain — two  per 
cent,  is  the  strength  of  ten  used  for  anesthesia — and  any  'cure' 
having  that  amount  is  dangerous.  Insanity  is  certain  if  its 
use  be  continued." 

The  following  table  showing  the  percentage  of  alcohol  in 
certain  patent  medicines  is  also  suggestive,  especially  in  view 
of  the  prevailing  energetic  campaign  against  beverages  which 
contain  greatly  less  percentages : 


COMPARISON  WITH  OTHER  SYSTEMS.  173 

Greene's  Nervura 17.2 

Hood's  Sarsaparilla 18.8 

Schenck's  Seaweed  Tonic 19.5 

Brown's  Iron  Bitters  19. 7 

Kaufman's  Sulfur  Bitters 20.5 

Paine's  Celery  Compound 21.0 

Burdock's  Blood  Bitters  25.2 

Ayer's  Sarsaparilla 26.2 

Warner's  Safe  Tonic  Bitters 35.7 

Parker's  Tonic 41.6 

Hostetter's  Stomach  Bitters . . . .  - 44.3 

Finally  it  remains  to  consider  as  a  definite  objection  to 
the  use  of  the  drug  the  .uncertainty  of  its  effects.  That  it 
is  uncertain  what  the  result  may  be  in  any  given  case  no  in- 
formed physician  will  deny.  The  search  for  "specifics"  has 
practically  been  abandoned  and  for  good  reasons.  The  fact 
that  every  living  individual  is  a  law  unto  himself  was  never 
more  clearly  emphasized  than  in  the  manner  in  which  differ- 
ent individuals  respond  to  the  drug,  or  the  same  individual  to 
the  same  drug  at  different  times.  Because  of  this  individual 
peculiarity  the  use  of  drugs  for  curative  purposes  can  never 
be  satisfactory  nor  scientific. 

The  following  paragraph  taken  from  an  article  in  the  July 
issue  of  the  American  Journal  of  Physiology  (On  the  Effects  of 
Subcutaneous  Injection  of  the  Extract  of  the  Suprarenal 
Capsule  upon  the  Blood-vessels  of  the  Rabbit's  Ear,  by  S.  J. 
Meltzer  and  Clara  Meltzer)  is  significant  in  connection  with 
the  above  considerations:  "Now  our  knowledge  of  the  effects 
of  all  drugs,  alkaloids,  toxins,  or  metabolic  products,is  most- 
ly derived  from  a  study  upon  normal  animals  or  organs.  Are 
the  effects  the  same  when  the  organs  are  deprived  of  their 
normal  innervation?  As  far  as  we  know  this  question  has  as 
yet  hardly  been  seriously  raised.  Our  experiments  have 
demonstrated  that  the  effect  on  pathological  organs  can  be 
diametrically  opposite  to  that  on  the  normal  ones!"  (p.  260.) 


174  PRINCIPLES  OF  OSTEOPATHY. 

ELECTROTHERAPY. 

The  various  forms  of  electric  application  are  made  use  of 
for  various  purposes  in  connection  with  disease.  At  one  time 
it  was  used  more  for  diagnosis  than  for  cure  and  in  this  re- 
spect at  the  present  it  is  of  some  value.  It  is  known  that  the 
application  of  a  current  to  a  nerve  produces  a  definite  and 
appreciable  change  in  that  nerve  technically  spoken  of  as 
electrotonus.  Comparisons  with  respect  to  this  condition  be- 
tween normal  and  abnormal  nerves  will  usually  show  distinct 
differences.  Hence  the  "reaction  of  degeneration"  is  an 
important  indication  of  disorder  of  a  nerve  structure.  The 
same  is  true  to  a  less  noticeable  degree  in  the  case  of  muscle 
tissue.  As  a  diagnostic  agent  it  may  further  be  of  value  in 
certain  medico-legal  relations,  in  determining  a  real  from  a 
simulated  condition.  In  those  cases  where  sinister  objects 
are  in  view  in  assuming  the  symptoms  of  a  particular  disease 
in  order  to  procure  damages,  the  application  may  in  many 
cases  absolutely  show  the  falsity  of  certain  of  the  claims. 

But  within  comparatively  recent  years  a  curative  value 
has  been  assumed  for  the  application,  and  with  the  rapid 
desertion  of  the  drug  by  both  laity  and  profession  recourse  is 
had  to  the  use  of  electricity.  In  general  the  same  purposes 
are  believed  to  be  accomplished  by  the  current  as  have  been 
assigned  to  the  drug.  McGregor -Robertson  (Physiological 
Physics)  enumerates  the  following:  stimulant,  counter-irritant \ 
anti-spasmodic,  electrolysis,  cautery.  Of  these  the  last  two  are 
primarily  surgical  in  their  use  and  as  such  may  have  their 
legitimate  place  in  the  surgeon's  armamentarium.  Monell 
and  Hay  em  both  suggest  a  specific  trophic  action  from  the 
application,  the  former  instancing  a  case  of  increased  growth 
in  stature  by  application  to  the  .  articulations.  This  action 
should  be  considered  as  a  subdivision  of  the  stimulant  action. 

Is  the  method  effective  or  satisfactory?  Let  the  au- 
thorities and  the  practitioners  experienced  in  that  method 
answer.  Hayem  {Physical  and  Natural  Therapeutics)  emphat- 


COMPARISON   WITH   OTHER   SYSTEMS.  175 

ically  declares  it  is  more  uncertain  than  the  drug.  Could  there 
be  a  stronger  statement !  In  this  connection  he  says :  "But 
the  reader  has  been  able  to  see  that  our  knowledge  is  still  not 
far  enough  advanced  for  us  to  think  of  formulating  in  a  pre- 
cise way  the  mode  of  action  of  electricity  upon  the  organism. 
The  only  certain  thing  seems  to  be  that  this  action  is  very 
complex  even  where  it  is  exerted  upon  a  healthy  organism. 
A  fortiori,  it  is  still  more  obscure  and  more  difficult  to  define 
when  we  are  working  in  a  therapeutic  way — i.  e.,  by  applica- 
tions upon  parts  modified  by  disease  or  upon  parts  whose 
manner  of  reacting  deviates  more  or  less  widely  from  the 
normal.  Moreover,  under  a  great  many  circumstances  we 
are  ignorant  of  the  real  conditions  under  which  we  are  intro- 
ducing the  electric  agent.  We  are  almost  absolutely  igno- 
rant of  the  pathological  physiology  of  the  neuroses  and  of 
most  of  the  diseases  of  the  nervous  or  neuro-motor  system, 
diseases  which  are  precisely  the  ones  in  which  electrization 
scores  its  most  incontestable  successes.  It  would  be  useless, 
therefore,  for  us  to  lay  any  stress  upon  the  various  theories 
upon  which  observers  have  thought  to  base  the  rational  em- 
ployment of  electricity.  Empirical  results  are  so  far  the 
only  ones  that  can  serve  us  as  a  guide. "  Verworn  in  his 
work  on  General  Physiology  declares,  "In  cases  where  by 
disease  a  portion  of  a  nerve  has  become  temporarily  impassi- 
ble to  stimuli,  medical  treatment  endeavors,  often  with  suc- 
cess, to  hinder  the  atrophy  of  the  tissue  supplied  by  the 
nerve  by  stimulating  it  artificially  by  electric  currents,  and  in 
this  action  of  the  galvanic  current  lies  the  therapeutic  importance  of 
electricity."  (Italics  mine).  Jacoby  in  his  two  volume  work 
on  the  subject  refers  more  or  less  at  length  in  no  less  than 
sixteen  separate  paragraphs  to  the  value  of  the  application 
because  of  its  psychic  effect.  Note  the  significance  of  this 
paragraph  found  on  page  133  of  Vol.  II :  "We  should  never 
forget  that  it  is  not  the  electricity  as  such  that  cures,  but 
that  it  is  the  entire  procedure  of  electrization,  with  all  the 
physical  and  psychic  effects  thereby  produced,"  and  in  an- 


176  PRINCIPLES   OF   OSTEOPATHY. 

other  paragraph  he  suggests  the  advisability  of  doing  all  ar- 
ranging of  apparatus  in  presence  of  the  patient  being  careful  to 
avoid  any  failure  in  the  attempt,  otherwise  the  suggestive 
effect  will  not  be  so  great. 

With  reference  to  the  value  of  the  Roentgen  ray  as  a 
therapeutic  influence,  little  can  be  said  at  the  present  time. 
Its  value  as  a  diagnostic  agent  is  unquestioned.  Sufficient 
experimentation  has  not  as  yet  been  made  relative  to  its 
therapeutic  value  to  warrant  definite  claims  one  way  or  an- 
other. As  a  surgical  accessory  in  removing  morbid  growth  it 
may  become  of  value.  Note  this  fundamental  fact,  however: 
The  ray  sufficient  in  intensity  to  destroy  a  micro-organism  or  a  cancer 
cell  will  also  be  sufficient  to  destroy  a  normal  body  cell,  and  further. 
the  ray  cannot  be  limited  in  its  course  or  in  its  effect  to  the  former. 
Here  we  have  seemingly  to  deal  with  conditions  that  con- 
fronted the  early  germ  theorists  who  attempted  to  render  the 
micro-organism  ineffective  by  giving  a  drug  definitely  de- 
structive to  it  only  to  find  that  while  the  germ  was  destroyed 
such  was  no  less  true  of  the  body  cell.  Further  evidence  for 
or  against  the  X-Ray  is  awaited,  confident  that  its  value  is 
limited  to  a  narrow  field. 

The  same  considerations  hold  with  respect  to  the  various 
forms  of  phototherapy,  whether  the  cure  be  in  the  form  of 
violet  rays,  green  rays,  or  allopathic  doses  of  ordinary  sun- 
light. All  rest  upon  the  same  basis. 

It  will  be  seen  by  a  careful  analysis  of  the  foregoing 
statements  that  the  foundation  for  the  practice  of  electro- 
therapy is  the  same  as  that  for  the  practice  of  drug  medication.  In 
other  words,  the  electrotherapists  are  still  fighting  the  battle 
from  the  rear  by  attempting  to  overcome  disease  by  combat- 
ing its  manifestations.  When  the  electrotberapist  applies  his 
battery  for  the  purpose  of  stimulating  a  lax  organ  he  is  using 
the  same  principle  that  the  drug  therapist  employs  in  the 
use  of  chemicals  for  the  stimulation  of  that  organ.  When  he 
reduces  a  sensory  condition,  as  of  a  neuralgia,  he  is  merely 
destroying  the  sensibility  of  that  nerve  in  a  manner  similar 


COMPARISON  WITH   OTHER   SYSTEMS.  177 

to  its  destruction  by  the  use  of  an  anodyne.  When  by  ap- 
plication of  electricity  for  secretory,  vaso-motor,  or  trophic 
effects  he  attempts  to  increase  metabolic  processes  he  is  still 
working  peripherally  rather  than  centrally.  The  real  cause 
of  disease  conditions  seems  to  be  an  unknown  quantity,  or 
the  assumption  is  made  that  the  removal  of  such  cause  is  out- 
side the  realm  of  possibility. 

HYDROTHERAPY. 

In  hydrotherapy  the  osteopath  has  in  numerous  cases  a  less 
objectionable  substitute.  Not  that  it  is  desirable  to  incorpor- 
ate its  practice  as  part  of  the  osteopathic  system  but  in  that 
with  the  present  development  of  the  osteopathic  science  proper 
our  ability  to  apply  distinct  and  effective  osteopathic  proced- 
ure is  limited.  It  is  further  to  be  noted  that  there  are  occa- 
sions where  emergencies  arise  which  can  only  be  met  with 
some  foreign  and  artificial  means.  In  most  cases  the  use  of 
water  as  a  vehicle  of  heat  or  cold  is  the  least  objectionable. 
Its  promiscuous  use  for  occasions  where  it  is  entirely  uncalled 
for  is  greatly  to  be  deplored.  Actual  practice  is  found  to 
need  but  an  occasional  use  of  such  methods  and  if  proper 
application  could  be  made  of  the  osteopathic  principle  such 
use  would  be  an  extreme  rarity. 

The  more  common  use  of  water  as  a  therapeutic  measure 
lies  in  its  value  as  a  thermal  agent.  In  many  cases  of 
high  temperature  it  is  a  distinct  advantage  for  purposes  of  re- 
ducing such  by  means  of  a  simple  sponge  bath  or  the  more 
extreme  and  dangerous  method  of  immersion.  So  far  as 
actual  experience  indicates  it  is  in  extremely  rare  cases  where 
the  latter  method  is  risked. 

Its  use  as  a  stimulant  is  of  some  value  in  certain  cases. 
Where  applied  locally  as  in  the  case  of  a  dash  of  water  in  the 
face  of  a  fainting  individual  it  is  not  associated  with  apparent 
danger;  but  where  applied  generally  the  reaction  is  always 
an  uncertain  quantity  and  hence  the  procedure  is  not  to  be 
advised  except  under  extraordinary  circumstances.  That  the 


178  PRINCIPLES   OF  OSTEOPATHY. 

value  of  the  reaction  is  as  uncertain  as  in  the  case  of  drugs 
cannot  be  questioned  and  rests  upon  the  fact  that  no  two  in- 
dividuals respond  in  the  same  way  to  the  application.  As  a 
general  stimulant  repeatedly  applied  it  is  a  pernicious  practice 
and  causes  a  condition  of  habit  little  less  objectionable  than 
that  of  the  drug.  For  there  is  no  question  that  the  simple 
practice  of  a  daily  cold  general  bath  is  not  an  unmixed  good. 
Man  is  not  an  aquatic  animal  so  far  as  his  external  surface 
is  concerned  and  neither  should  his  normal  metabolism  be 
made  to  depend  on  the  artificial  stimulus  supplied  by  the 
daily  stimulating  bath.  Note  that  there  are  extremes  in  both 
directions.  We  do  not  argue  for  uncleanliness  but  we  insist 
that  a  distinction  be  made  between  an  excretion  and  a  secre- 
tion. Herein  lies  the  fallacy  of  the  one  extremist  who  insists 
that  the  "pores  must  be  kept  open"  by  continual  washing  with 
soap  in  order  that  the  excretions  may  be  removed.  We  insist 
that  the  skin  is  as  much  a  secretory  as  an  excretory  organ.  This 
is  especially  true  with  relation  to  the  sebaceous  glands  the 
sebum  from  which  acts  as  a  nutrient  material  to  the  hair,  an 
oil  for  both  hair  and  skin,  and  a  protection  against  infection 
over  the  entire  body  surface.  It  is  a  peculiarity  of  the  sebum 
that  the  fats  which  it  contains  do  not  become  rancid,  i.  e., 
they  are  unfavorable  soil  for  the  development  of  micro-organ- 
isms. He  who  robs  the  skin  of  this  material  by  repeated 
applications  of  soap  opens  an  easy  pathway  for  infection. 

A  further  use  for  the  application  of  water  is  as  a  sedative. 
Tt  is  common  knowledge  that  numerous  cases  of  pain  asso- 
ciated with  an  inflammatory  lesion  may  often  be  lessened  by 
the  application  of  either  heat  or  cold,  the  choice  of  which  is 
largely  determined  by  experiment  with  each  individual  case. 

In  numerous  cases  of  constipation  the  warm  water 
enema  is  valuable.  Especially  is  this  true  in  the  various  con- 
ditions of  impaction  where,  associated  with  the  opening  up  of 
the  bowel  by  manipulation  the  movement  can  be  effected  with 
less  difficulty.  In  this  connection  a  word  of  caution  is  neces- 
sary. The  writer  has  had  occasion  to  examine  a  number  of 


COMPARISON   WITH   OTHER   SYSTEMS.  179 

cases  of  atony  of  the  rectum  which  he  was  persuaded  were 
direct  results  of  the  regular  use  of  the  enema.  It  is  absolute- 
ly as  true  of  the  enema  as  it  is  of  the  drug-  that  after  continual 
use  the  bowel  becomes  largely  dependent  on  the  abnormal 
stimulus  for  its  movement  and  like  the  drug  requires  increas- 
ingly more  intense  application.  No  claim  for  cleanliness  or 
haste  can  justify  other  than  an  occasional  use  of  the  injection;  for 
it  must  be  remembered  that  all  mucous  membranes  are  self-cleans- 
ing and  as  such  do  not  require  the  continual  ablutions  to 
which  some  individuals  are  unfortunately  subjected.  These 
considerations  hold  good  not  only  for  the  mucous  membrane 
of  the  rectum  but  are  equally  true  with  reference  to  lavage  of 
the  stomach,  to  vaginal  douches,  and  to  the  washing  out  of 
the  bladder.  In  all  these  cases  the  normal  cleansing  and 
protecting  material — mucous — is  removed,  the  glands  become 
over -stimulated,  and  finally  from  lack  of  nprmal  protection 
various  pathological  conditions  are  produced  or  established. 

PSYCHOTHERAPY. 

The  rapid  rise  of  a  large  number  of  cults  who  claim  to  be 
able  to  overcome  disease  through  application  of  the  fact  that 
the  mind  has  a  direct  influence  over  the  body  metabolism  is 
one  of  the  remarkable  facts  of  the  last  half  century.  Whether 
they  be  styled  Christian  Science,  magnetic  healing,  faith 
cure,  or  simple  mind  healing,  all  are  based  upon  the  one 
principle.  That  cases  presenting  considerable  functional  dis- 
turbance have  been  permanently  cured  under  the  ministrations 
of  their  followers  is  no  longer  questioned.  In  all  of  their  con- 
tentions, absurd  as  some  of  them  may  be,  there  is  an  element 
of  truth.  That  body  affects  mind  and  that  in  turn  mind 
affects  body  are  propositions  subject  to  no  dispute.  The  ex- 
tent of  that  influence  in  either  case  constitutes  the  battle 
ground  of  the  contestants.  At  the  basis  of  their  philosophy 
we  find  a  tenet  which  is  fundamental  to  the  osteopathic  con- 
ception and  that  is  what  has  been  repeatedly  emphasized, 
that  it  is  the  organism  and  not  the  physician  that  cures,  and 


180  PRINCIPLES   OF  OSTEOPATHY. 

that  nature  has  a  remarkable  power  of  self -restoration.  The 
objection  to  the  psychotherapist  of  the  extreme  school  is  that 
he  fails  to  recognize  that  there  must  be  a  limit  and  in  reach- 
ing that  limit  nature  must  be  aided  before  further  progress 
can  be  made.  Herein  lies  the  physician's  duty. 

It  is  not  advisable  at  this  time  to  enter  into  detail  with 
reference  to  the  methods  or  means  of  suggestion  as  a  thera- 
peutic agent  but  a  principle  may  be  enunciated  which  will 
cover  all  cases  of  disordered  mental  conditions  or  body  con- 
ditions resulting  from  the  mental  disturbance.  In  the  first 
place  it  will  be  noted  that  so- called  purely  psychic  di sorders  will 
be  the  ones  most  readily  overcome  by  the  mental  healer. 
There  is  such  a  condition  which  we  may  designate  as  the  vital 
level,  fluctuations  and  disturbances  of  which  may  be  caused 
by  extraordinary  mental  or  emotional  activity.  This  disturb- 
ance of  the  vital  level  will  only  be  a  temporary  one,  the  or- 
ganism itself  seeking  its  own  level  and  restoring  its  own 
equilibrium.  In  case  the  mental  or  emotional  excitement  be 
extreme  in  intensity  or  prolonged  in  time  structural  conditions 
may  be  disturbed  as  a  result  of  the  extreme  mental  or  emotion  - 
al  functioning.  Even  then  in  many  cases  the  vital  level  will 
be  restored,  the  structural  changes  having  been  overcome 
following  the  cessation  of  the  psychic  disturbance.  But  as 
has  been  indicated  in  other  sections  structural  conditions  are 
less  immediately  under  the  control  of  the  reparative  forces 
and  hence  will  be  more  likely  to  persist.  When  such  do  per- 
sist the  vital  level  is  not  restored  and  we  have  presenting  a 
real  structural. lesion.  With  such  a  case  the  osteopath  has 
especially  to  deal  in  the  removal  of  this  secondary  lesion.  The 
principle  for  which  we  contend  in  all  these  cases  is  that  mental 
and  emotional  as  well  as  body  conditions  constantly  tend  toward  the 
normal  and  if  open  channels  of  interchange  are  maintained 
between  the  cells  at  the  basis  of  psychic  functioning  and  their 
sources  of  supply  those  psychic  functions  will  be  restored  in 
their  integrity.  The  continued  over- exercise  of  the  psychic 
functions  such  as  over-study,  worry,  and  the  like,  constitute 


COMPARISON   WITH   OTHER   SYSTEMS.  181 

an  abuse  of  psychic  functioning,  the  abstinence  from  such 
abuse  constituting  the  only  necessary  treatment  in  cases  un- 
complicated by  obstructive  lesion.  In  psychic  conditions, 
then,  we  have  to  deal  with  cases  essentially  similar  to  body  con- 
ditions, for  so  far  as  our  work  is  concerned  the  psychic  activi- 
ties are  the  functions  of  certain  nerve  cells.  Those  functions 
will  be  normal  if  the  structures  at  their  basis  are  kept  in  a 
condition  of  normal  nutrition,  and  since  every  case  of  any 
severity  invariably  presents  more  or  less  marked  lesion,  the 
treatment  will  be  different  only  in  the  manner  of  helping  the 
patient  in  abstaining  from  further  abuse. 

MECHANOTHERAPY. 

The  subject  of  cure  by  manipulations  and  exercises  of  an 
active  nature  has  in  late  years  gained  a  remarkable  promi- 
nence. As  one  of  the  results  of  this  interest  in  mechanical 
methods  there  is  an  unfortunate  tendency  on  the  part  of  many 
to  assume  that  osteopathy  is  but  a  special  form  of  what  others 
have  long  been  applying  under  the  name  of  massage  or  Swed- 
ish movements.  That  there  are  seeming  similarities,  both  in 
the  objects  in  view  and  in  methods  of  treatment  no  one  will 
deny.  But  that  these  similarities  are  only  apparent  while  the 
real  difference  is  fundamental  is  a  proposition  agreed  to  by 
every  one  who  takes  the  pains  to  investigate.  It  seems  wise 
therefore  to  enter  somewhat  in  detail  into  the  subject. 

For  the  purpose  of  working  upon  safe  ground,  it  is 
necessary  to  have  a  definite  understanding  as  to  what  con- 
stitutes massage  and  these  other  mechanico- therapeutical 
measures.  According  to  Kleen,  "By  massage  (which  means 
to  press  or  to  knead)  we  mean  a  mechanical  action  which  is 
performed  on  the  soft  tissues  for  a  therapeutical  purpose,  by 
means  of  certain  manipulations,  namely,  stroking,  rubbing, 
kneading  and  striking."  Kellgren,  after  Ling,  includes  in 
massage  also  shakings  and  vibrations.  Although  massage 
strictly  does  not  include  the  gymnastic  movements  which 
involve  the  exercise  of  the  organs  of  motion,  and  Swedish 


182  PRINCIPLES   OF   OSTEOPATHY. 

movements  strictly  do  not  include  massage  procedures,  yet 
in  practice  and  in  the  theory  of  effects  of  these  procedures 
the  two  are  so  interwoven  that  they  may  with  all  propriety  be 
considered  together. 

To  indicate  the  development  of  mechanical  therapeutics 
it  will  not  be  amiss  to  give  a  brief  statement  of  its  history. 
Some  idea  of  massage  and  its  effect  probably  has  been  known 
from  the  earliest  times.  The  ancient  Persians,  the  Egyptians, 
and  even  the  Chinese,  3000  B.  C.,  made  use  of  these  physical 
means  of  cure.  Among  the  Greeks  considerable  progress 
was  made  a  century  B.  C.  Hippocrates  refers  to  the  use  of 
frictions  in  sprains,  luxations  and  constipation,  and  records  a  list 
of  cases.  Among  the  Romans  massage  and  gymnastic  ex- 
ercises were  in  high  repute,  and  in  the  second  century  of  our 
era  Galen  made  considerable  study  and  application  of 
mechanotherapy.  Like  other  elements  of  civilization  during 
the  dark  ages,  little  progress  was  made.  In  the  fourteenth 
century  when  anatomy  was  studied  with  greater  enthusiasm 
than  ever  before,  the  system  was  revived,  and  from  that  time 
to  the  present  has  had  a  more  or  less  varied  experience.  That 
a  knowledge  of  the  effects  of  mechanotherapy  was  more  or 
less  prevalent  in  the  time  of  Lord  Bacon  is  indicated  from 
the  writings  of  that  distinguished  man  who  says:  "Frictions 
make  the  parts  more  fleshy  and  full,  as  we  see  both  in  men 
and  in  the  currying  of  horses.  The  cause  is  that  they  draw 
a  greater  quantity  of  spirits  and  blood  to  the  parts ;  and  again 
they  draw  the  aliments  more  forcibly  from  within ;  and  again 
because  they  relax  the  power  and  so  make  the  better  passage 
for  the  spirits,  blood,  and  aliment;  lastly,  because  they  dissi- 
pate and  digest  any  inutile  and  excrementitious  moisture 
which  lieth  in  the  flesh,  all  of  which  helps  assimilation."  In 
the  early  part  of  the  seventeenth  century,  massage  was  made 
to  contribute  to  the  service  of  beauty.  Hoffman,  in  the  early 
part  of  the  eighteenth  century  greatly  assisted  in  the  promo- 
tion of  mechanotherapy  by  his  works,  more  particularly  his 
writings.  He  declares  "that  on  account  of  their  influence 


COMPARISON   WITH   OTHER  SYSTEMS.  183 

upon  the  circulation,  the  appetite  and  general  condition, 
gymnastics  are  the  best  of  all  remedies,"  and  also  following 
Hippocrates  and  Galen, treats  quite  fully  of  massage.  Follow- 
ing Hoffman,  individuals  in  Germany,  England  and  France, 
separately  and  after  their  own  manner  contributed  to  the 
development. 

Mechanotherapy  in  Sweden  began  largely  with  Peter 
Henry  Ling  who  lived  from  1776  to  1839  and  from  him  the 
Swedish  movements  as  a  system  dates  its  origin.  Ling 
was  essentially  a  gymnast,  being  a  teacher  of  gymnastics  and 
fencing  in  the  university  of  .Lund,  and  it  was  the  beneficial 
effects  of  the  movements  upon  himself  that  led  to  the  develop- 
ment of  his  system.  While  employing  these  movements  of 
the  body  for  therapeutical  effects,  however,  he  did  not  neglect 
massage  but  recognized  its  helpfulness  and  incorporated  it 
as  a  part  of  the  Swedish  movement  system.  Although  this 
system  is  constantly  associated  with  Ling's  name,  he  by  no 
means  originated  the  several  movements  comprising  it  but 
undoubtedly  he  did  exert  a  large  influence  on  organizing  the 
various  therapeutical  measures  thereby  creating  a  distinct 
system. 

It  is  since  the  middle  of  the  nineteenth  century  that 
mechanotherapy  has  made  its  greatest  advance,  and  in  Hol- 
land, in  Germany,  in  Austria,  in  England,  and  in  France,  as 
well  as  in  Norway  and  Sweden,  physical  methods  of  healing 
have  been  and  are  being  developed.  In  summing  up,  Kleen 
remarks  that  massage  as  yet  hardly  holds  the  place  in  thera- 
peutics to  which  it  is  entitled,  and  suggests  as  an  explanation 
of  this  fact  two  reasons :  First,  the  practice  has  largely  been 
in  the  hands  of  unscientific  persons  and  therefore  in  many 
cases  has  been  more  harmful  than  helpful;  second,  using  his 
own  words,  "it  must  also  be  admitted  that  the  unsatisfactory 
standing  of  mechanotherapy  is  partly  the  fault  of  us  physi- 
cians. Hitherto  the  world  of  scientific  medicine  has  neg- 
lected this  form  of  treatment,  the  practice  of  which  is  always 
more  troublesome  than  writing  prescriptions  and  almost  al- 


184  PRINCIPLES   OF   OSTEOPATHY. 

ways  less  remunerative.  Very  many  physicians  are  still  so 
ignorant  of  mechanotherapy  that  they  are  alike  unable  to 
understand  it  or  to  teach  it  to  others.  Finally,  there  is  a  class 
of  men  in  our  profession  afflicted  with  what  I  should  call 
intellectual  snobbery,  who  will  on  general  principles  have 
nothing  to  do  with  a  method  of  treatment  that  calls  for  me- 
chanical labor."  Further,  quoting  from  Kellgren  regard- 
ing the  slowness  of  the  development  of  mechanotherapy,  we 
note  this  complaint  which  has  such  a  familiar  ring :  "The 
result  of  the  manual  method  in  these  and  other  nervous  dis- 
eases would  be  still  more  successful  if  the  patients  had  re- 
course to  the  treatment  sooner.  At  present  it  is  used  as  the 
last  plank  after  everything  else  has  failed.  Not  only  then 
have  we  to  contend  with  the  diseases  in  their  very  advanced 
stage,  but  also  with  the  sunken  courage  and  lost  energy  of  the 
patient  which  reacts  so  unfavorably  on  his  general  health." 

Passing  to  a  consideration  of  the  technique  of  massage 
several  forms  of  manipulation  are  described.  Effleurage  con  - 
sists  of  a  series  of  strokings  over  a  portion  of  the  skin  or  other 
soft  tissues  in  a  centripetal  direction.  The  more  pronounced 
and  immediate  effect  of  this  is  acceleration  in  the  circulation 
of  the  blood  and  lymph  through  the  local  part.  According 
to  Ling  slight  strokings  tend  to  soothe  pain  in  the  superficial 
structures  as  well.  Frictions  are  in  the  nature  of  rubbings  in 
a  circular  direction  over  small  areas  and  are  employed  to  pro- 
mote absorption.  Petrissage  consists  in  a  kneading  of  the 
tissues  either  between  the  thumb  and  fingers  of  the  operator 
or  against  bony  and  other  tissues  of  the  body  of  the  patient. 
It  is  supposed  also  to  aid  absorption  and  acts  as  a  mechani- 
cal stimulation  of  the  muscles  as  well  as  producing  an  effect 
on  the  nerve  terminals  within  the  tissue.  Tapotement  consists 
of  light  blows  or  choppings  given  by  the  flat  of  the  hand,  the 
fingers,  or  the  edge  of  the  fist,  and  acts  as  a  mechanical  ex- 
citant of  muscle  and  nerve,  the  excitation  causing  contrac- 
tion of  muscular  tissue  which  results  in  increased  activity  of 
the  flow  through  superficial  vessels  and  nerves.  The  shaking 


COMPARISON   WITH   OTHER   SYSTEMS.  185 

movements  as  given  by  Ling,  are  applied  to  portions  of  the 
body  more  or  less  easily  moved  and  are  advantageous  in 
promoting  absorption,  in  its  stimulating  effect,  and  in  its  re- 
duction of  congested  and  inflammatory  conditions  thereby 
lessening  pain  and  increasing  glandular  activity.  This  move- 
ment is  applied  to  the  pharynx,  larynx,  thorax,  and  abdomen, 
as  typical  cases.  For  instance,  in  its  application  to  the  lower 
part  of  the  thorax,  the  operator  places  one  hand  on  either 
side,  making  quick  compressions  and  relaxations,  thus  in- 
fluencing chest  and  abdominal  activities.  A  modification  of 
the  shaking  movement  is  seen  in  -vibration  and  is  applied  to 
the  eyes,  throat,  chest,  and  abdomen.  The  effect  is  similar 
to  that  of  the  shaking  movement  but  is  supposed  to  be  es- 
pecially efficient  in  reducing  disturbed  sensory  conditions. 
In  distinctively  kneading  movements  effects  are  gotten  on  im- 
pacted bowels  by  direct  work  along  the  course  of  the  intes- 
tine, while  kneading  associated  with  the  shaking  movement 
is  declared  to  be  helpful  in  biliary  calculus. 

As  to  the  special  effects  secured  by  the  masseur,  there 
are,  according  to  the  latter,  many  that  the  osteopath  undoubt- 
edly secures  indirectly.  He  often  meets  cases  which  are 
more  or  less  addicted  to  the  treatment  habit,  and  who  apply 
at  his  office  for  a  "toning  up"  treatment  to  relieve  them  of 
the  feeling  of  exhaustion.  Masseurs  have  the  same  idea  in 
mind  when  they  indicate  that  massage,  more  particularly  ef - 
fleurage,  aids  very  materially  in  overcoming  fatigue  in  groups 
of  tired  muscles.  The  products  of  muscle  katabolism,  which 
are  largely  responsible  for  the  feeling  of  fatigue, are  thus  forced 
out  more  rapidly  making  way  for  nutritive  supplies.  Further, 
as  Kleen  states,  massage  acts  both  as  a  pressure  and  suction 
pump.  The  forcing  of  the  fluid  from  the  tissue  creates  a 
negative  pressure  which  acts  as  a  further  force  in  circulation. 
This  fact  is  taken  account  of  in  conditions  of  an  inflammatory 
character  which,  as  the  masseurs  themselves  point  out,  be- 
gin with  the  dilatation  of  the  small  vessels  of  the  part,  with  a 
subsequent  slowing  of  the  blood  stream.  Hence  in  the  treat- 


186  PRINCIPLES   OF   OSTEOPATHY. 

ment  which  consists  of  working  around  an  inflamed  area  as 
in  appendicitis,  or  tonsilitis,  or  gastritis  the  osteopath  is  do- 
ing merely  what  the  masseur  does.  A  case  is  cited  in  this 
connection  of  a  cure  in  retention  of  urine  from  an  enlarged 
prostate  by  direct  manipulation  of  the  gland,  a  procedure 
many  osteopaths  are  free  to  advise  and  use.  A  further  effect 
is  claimed  for  massage  in  the  prevention  and  possible  cure  of 
muscular  atrophy,  at  least  where  that  atrophy  is  due  to  pe- 
ripheral causes,  for  example  lack  of  exercise  of  a  certain 
muscle  group.  In  this  case  there  is,  according  to  the  reason- 
ing of  the  masseur  a  trophic  effect,  either  through  the  medium 
of  special  trophic  nerves  or  through  the  direct  blood  supply. 
And  they  have  recognized  a  further  effect  of  massage  than  the 
mere  local  and  direct  influence  on  blood  flow;  for  in  speak- 
ing of  tapotement  having  an  effect  on  the  heart  Kleen  says: 
"So  far  as  the  human  subject  is  concerned,  little  more  can  be 
said  than  that  massage,  no  matter  how  it  is  employed,  pro- 
duces reflex  effects  both  during  and  after  its  application, 
which  effects  are  seen  in  the  narrowing  as  well  as  in  the 
widening  of  certain  blood  vessels;  in  the  rise  as  well  as  in 
the  fall  of  arterial  blood  pressure;  in  the  quickening  as  well 
as  in  the  slowing  of  the  pulse.  Still  it  is  safe  to  say  that  the 
particular  character  of  these  effects  is  determined  by  the 
manner  in  which  the  massage  is  given,  by  the  place  in  which 
it  is  applied,  and  the  organs  reached  by  it,"  and  he  refers  to 
the  common  experiment  showing  that  after  massage  of  one 
arm,  probably  through  a  vaso- motor  effect  a  dilatation  or  a 
constriction  of  the  vessels  of  the  other  arm  results.  He  also 
speaks  of  a  rise  of  blood  pressure  during  addominal  massage 
due  to  a  constriction  of  the  arteries  of  the  mesentery. 

A  further  result  to  be  gained  by  massage  is  in  the  break- 
ing down  of  newly  formed  capillaries  where  new  growths 
are  developing.  Frictions  are  the  procedures  employed  and 
in  this  connection  the  osteopath  naturally  thinks  of  his  de- 
struction of  the  "feeders"  in  certain  congested  and  inflamed 
conditions  of  the  external  coats  of  the  eye  or  the  eyelids. 


COMPARISON  WITH  OTHER  SYSTEMS.  187 

Ziegenspeck  refers  also  to  massage  for  the  breaking  down  of 
adhesions  between  the  uterus  and  rectal  wall. 

Another  purpose  for  which  the  masseur  works  is  one 
which  osteopaths  constantly  have  in  mind,  namely,  the  con- 
trol of  circulation;  and  the  result  is  gotten,  not  only  by 
the  influence  exerted  on  general  blood  flow  and  blood  pressure 
through  the  medium  of  vaso- motors,  as  for  instance  when 
Kellgren  indicates  that  shaking  or  other  manipulation  at  the 
pit  of  the  stomach  exerts  a  direct  influence  on  the  circulation 
of  the  abdomen  and  hence  of  the  entire  body,  or  in  another  ex- 
ample in  which  he  cites  the  relief  of  headache  and  congestion 
of  the  brain  by  work  in  influencing  the  circulation  to  the  head 
through  the  effect  gotten  on  the  occipital  nerves  \  but  he  also 
attempts  a  direct  control  of  the  blood  flow  as  evidenced  by 
cases  cited  of  circulation  changes  by  direct  pressure  on  the 
abdominal  aorta  and  of  the  relief  of  fainting^from  shock  by 
pressure  on  the  internal  jugular  veins. 

There  are  those  who  insist  that  in  nerve  massage  and 
vibration  the  masseur  has  his  most  efficient  therapeutic 
measure.  As  illustrative  of  the  application  the  following  cases 
are  cited  by  various  authors :  overcoming  the  spasmodic  action 
of  the  diaphragm  both  by  inhibition  at  the  origin  of  the  nerve 
and  by  shakings  applied  at  the  pit  of  the  stomach ;  trouble  with 
the  eye  in  which  direct  pressure  is  made  on  the  eyeball  itself 
thereby  stimulating  its  nerve  mechanism ;  vibration  of  the  nasal 
and  supra-trochlear  branches  of  the  fifth  in  catarrh  of  the  nose 
and  frontal  headache ;  vibrations  of  the  dental  branches  of  the 
fifth  resulting  in  the  relief  of  neuralgic  toothache;  the  striking 
example  given  by  Ziegenspeck  in  which  he  claims  that  slight 
choppings  on  the  back  and  percussions  transversely  across 
the  sacral  region  are  said  to  induce  the  central  nervous  system 
to  exercise  a  tonic  influence  upon  the  relaxed  ligaments  of  the 
uterus',  the  still  more  remarkable  instance  in  which  Kellgren's 
work  states  in  regard  to  frictions  along  the  pneumogastric 
nerve,  "its  effect  upon  the  heart  is  utilized  when  the  action 
of  the  latter  is  too  strong, "or  referred  to  by  Kleenin  thiswise, 


188  PRINCIPLES   OF   OSTEOPATHY. 

"I  would  point  out  that  though  we  may  by  pres8ure  upon 
the  vagi  in  the  neck  cause  slowing  and  even  cessation  of  the 
heart,  still  it  is  by  no  means  a  harmless  procedure  and  its 
usefulness  under  any  circumstances  whatever  remains  to  be 
proven;"  and  still  another  example  as  given  by  Kleen  in 
which  stretching  the  sciatic  nerve  is  advised  in  case  of  sciatic 
rheumatism.  Not  only  is  this  direct  effect  gotten  by  means 
of  nerve  stimulation  but  also  the  possibility  of  affecting  remote 
organs  through  reflex  activities  is  granted.  In  Kellgren's 
work  the  following  summary  is  given  relative  to  the  effects  of 
nerve  vibrations :  "First,  raising  of  the  nervous  energy ;  sec- 
ond, diminution  of  pain;  third,  contraction  of  the  smaller 
blood  vessels;  fourth,  stimulation  of  the  muscles  to  contrac- 
tion; fifth,  increased  secretion  of  the  glands;  sixth,  diminish- 
ed excretion  from  the  skin ;  seventh, decrease  of  temperature. ' ' 

Finally,  masseurs  are  aware  of  the  fact'and  the  possible 
significance  of  tender  points  in  the  tissues  along  the  spine 
over  the  area  from  which  nerves  are  given  off  to  organs  which 
are  in  a  diseased  condition ;  evidently,  however,  they  have 
considered  these  tender  points  as  always  secondary  to  the 
diseased  viscus.  Cases  are  cited  in  one  of  which  where  there 
was  a  disease  of  the  lungs,  the  patient  was  very  sensitive  along 
the  spine  between  the  shoulder  blades,  and  in  another,  diseases 
of  the  generative  organs,  the  bladder,  and  rectum  were  found 
associated  with  various  tender  places  along  the  lumbar  and 
sacral  regions. 

Thus  far  it  has  been  indicated  that  in  many  ways  there 
is  a  similarity  between  the  various  systems  of  mechanotherapy 
and  that  of  osteopathy.  It  remains  to  substantiate  the  propo- 
sition that  there  is  a  difference  essential  in  kind  and  funda- 
mental in  importance.  What  is  that  vital  difference?  A  few 
differences  have  been  presented  to  the  public  which  are  cer- 
tainly non-essential.  It  is  declared  that  massage  is  general 
in  its  application,  osteopathy  specific;  that  it  is  only  very 
rarely  that  massage  is  given  to  local  parts  for  local  troubles. 
From  what  has  been  said  above  it  will  be  seen  that  this  dis- 


COMPARISON   WITH   OTHER   SYSTEMS.  189 

tinction  is  decidedly  lame.  "While  the  general  treatment  in 
massage  holds  prominent  sway,  to  declare  that  local  treat- 
ment for  local  effect  is  very  rarely  used  is,  to  say  the  least, 
over-stepping  the  bounds  of  caution.  It  will  be  seen  from  the 
foregoing  that  massage  can  be  as  specific  in  its  application 
as  is  osteopathy  so  far  as  localizing  the  treatment  is  con- 
cerned. A  second  distinction  made  is  that  massage  is  only  a 
part  of  a  system  while  osteopathy  covers  the  whole  field  of 
disease.  A  very  little  analysis  only  will  be  necessary  to  in- 
dicate the  non-essential  character  of  this  distinction.  It  is 
true  that  osteopaths  claim  that  their  science  covers  the  whole 
field  of  disease.  It  is  also  true  that  there  are  numerous  dis- 
eases with  which  osteopathy  has  not  yet  come  in  contact,  and 
further  there  are  numerous  diseases  over  which  osteopathy 
so  far  has  not  been  able  to  exercise  much  control.  Admitting 
this  is  not  granting  that  in  a  further  development  of  the 
science  it  will  not  be  able  to  control  these  diseases.  So  far 
as  the  masseurs  are  concerned,  they  make  the  claim  for  their 
practice  that  it  is  being  found  applicable  to  more  and  more  of 
the  disease  conditions,  and  that  the  ultimate  status  of  the 
system  cannot  be  foretold.  A  third  distinction  which  is  made 
is  that  while  osteopathic  practice  necessitates  a  thorough 
knowledge  of  anatomy,physiology,andetiology,these  branch- 
es are  not  essential  in  massage.  This  so-called  distinction, 
while  indicating  an  ignorance  of  the  practice  of  massage  is 
also  grossly  unjust  to  the  followers  of  that  system.  The  dis- 
tinction merely  compares  the  well  trained  osteopath  to  the  un- 
instructed,  untrained  masseur,  the  unfairness  of  which  is 
evident.  True,  a  large  number  of  the  masseurs  are  unin- 
structed  in  these  branches  but  are  trained  to  perform  certain 
movements  and  are  under  the  direction,  in  many  cases,  of  a 
regular  physician ;  the  osteopath  might  take  an  ignorant  man 
and  without  any  instruction  in  these  branches  teach  him  to 
perform  certain  osteopathic  manipulations  which  would  be 
productive  of  good  results,  and  yet  should  the  claim  be  made 
that  he  were  a  representative  of  osteopathy  a  storm  of  ob- 


190  PRINCIPLES    OF   OSTEOPATHY. 

jection  would  arise.  There  are  fake  masseurs  and  assistant 
masseurs  as  well  as  fake  osteopaths  and  assistant  osteopaths. 
The  essential  distinction  between  osteopathy  and  all 
other  systems  of  healing  based  on  manipulation  clusters 
around  the  etiology  of  disease.  While  these  other  systems,  as 
indicated  at  least  by  their  practice,  look  at  disease  from  a 
peripheral  standpoint,  osteopathy  views  it  from  a  central 
standpoint.  Starting  with  the  cell  theory  as  a  basis,  they 
have  regarded  life  and  hence  disease  as  a  series  and  a  com- 
plication of  cell  activities.  Taking  a  concrete  case,  a  certain 
set  of  cells  constitutes  the  liver.  Under  normal  conditions  the 
part  taken  by  the  liver  in  the  life  of  the  organism  consists  in 
the  sum  of  the  activities  of  that  particular  group  of  individual 
cells.  A  diseased  condition  of  the  liver  is  but  the  activity  of 
the  cells  in  the  group, abnormal  in  kinder  quantity;  hence  re- 
medial measures  have  been  applied  directly  to  them.  The 
masseur,  by  compression,  stroking,  shaking,  or  nerve  stimu- 
lation, acts  directly  upon  the  liver.  On  the  other  hand,  the 
osteopath,  taking  into  consideration  the  ability  of  nature  to 
functionate  properly,  recognizes  a  central  force  sufficient  to 
keep  in  normal  action  this  particular  group.  And  when  a 
disturbance  in  the  normal  activity  of  those  cells  is  manifest 
he  reasons  that  the  influence  from  this  central  force  to  the  in- 
volved cell  group  has  been  obstructed,  diverted,  or  otherwise 
interfered  with,  and  his  work  consists  in  discovering  the 
nature  of  that  interference,  the  point  of  interference,  and  the 
removal  of  interference.  This  constitutes  the  only  purely 
osteopathic  consideration  of  health  and  disease,  and  if  a 
differentiation  is  made  between  osteopathy  and  the  other 
forms  of  mechanotherapy,  this  is  the  view  that  must  be  ac- 
cepted. 

SUMMARY. 

A  few  of  the  facts  relative  to  the  more  important  of  mod- 
ern methods  of  dealing  with  disease  have  been  touched  upon 
and  if  care  has  been  taken  it  will  be  observed  that  there  is  a 


COMPARISON   WITH   OTHER   SYSTEMS.  191 

remarkable  similarity  of  basis  throughout.  We  are  pre- 
pared to  insist  that  the  bases  are  identical ;  that  a  difference 
between  any  two  is  a  difference  in  detail  and  in  degree  only, 
not  a  difference  in  essentials.  The  basis  of  all  the  methods  is 
that  enunciated  boldly  by  the  drug  therapists,  treat  the  symp- 
toms as  they  arise.  In  so  far  as  any  system  is  guided  by  such  a 
rule  of  practice  it  must  occupy  an  illogical  position.  The 
manner  of  treatment  of  symptoms,  if  such  treatment  be 
necessary,  is  a  comparatively  inconsequent  matter.  It  is  not 
meant  by  this  that  one  method  is  necessarily  as  good  as 
another  in  accomplishing  the  result,  for  such  is  hardly  true. 
But  it  must  be  insisted  that  the  position  assumed  is  funda- 
mentally the  same.  On  this  basis  the  phrase  "natural 
methods,"  in  common  use,  is  a  misnomer.  No  method  is  a 
natural  method  where  artifice  is  necessary.  Only  that  method 
is  natural  in  which  the  organism  unaided  effects  a  cure.  The 
reason  for  the  inclusion  of  every  known  method  with  the  lone 
exception  of  drug  healing  in  the  category  of  "natural  methods" 
must  be  regarded  as  a  profound  enigma.  Why  this  singling 
out  of  the  drug?  If  it  be  natural  for  the  sick  man  to  expose 
his  nude  body  to  the  burning  rays  of  the  sun  in  taking  the 
"sun  cure" ;  or  to  inject  or  otherwise  use  continued  excess  of 
water  in  the  method  of  the  hydrotherapist;  or  to  introduce 
into  the  body  a  charge  of  electric  energy  ;or  to  ignore  the  fact 
of  disease  ;or  even  to  apply  manipulative  stimulation  or  inhibi- 
tion; it  certainly  is  no  less  so  to  administer  a  dose  of  soda  for 
a  sour  stomach.  Demonstrate  that  there  is  fundamentally 
any  difference  in  the  absolute  between  the  action  of  the  drug 
and  the  action  of  these  others  and  there  will  be  reason  to  con- 
fine condemnation  to  that  alone  as  being  unnatural.  This  is 
no  plea  for  the  drug.  It  is  undoubtedly  true  that  of  them  all 
the  drug  is  associated  with  the  greatest  possibility  of  danger, 
but  it  must  be  insisted  that  that  fact  does  not  make  any  dis- 
tinction in  kind.  The  author  is  opposed  to  all  of  them  on  the 
basis  that  they  are  all  illogical  methods;  but  in  those  cases 
where  a  logical  method  is  not  available  it  may  be  advisable  to 


192  PRINCIPLES   OF   OSTEOPATHY. 

resort  to  that  least  associated  with  danger.  He  who  persists  in 
inchiding  in  the  osteopathic  system  these  so-called  natural  systems 
has  no  aiithority  to  exclude  the  drug.  In  so  far  as  he  does  include 
all  these,  his  is  not  a  system  but  a  conglomerate  and  the 
practitioner  should  be  willing  to  take  his  proper  place  among 
the  naturopaths  whose  practice  he  follows  but  whose  claim  on 
his  allegiance  he  ignores. 

Hence  in  the  case  of  a  disorder  of  an  aggregation  of 
cells — a  viscus  for  instance — what  is  the  treatment  by  the 
practitioner  of  other  schools?  It  is  the  same  in  principle 
whether  the  agent  be  drug,  electricity,  water,  heat,  light, 
suggestion,  or  mechanical  stimulation.  If  the  organ  be  slug- 
gish a  stimulant  is  given.  An  excess  of  impulses  presum- 
ably reaches  the  organ  which  causes  increased  activity.  What 
matter,  fundamentally,  whether  the  excess  result  from  drug 
or  nerve  impulse  from  higher  center,  from  mechanical  irrita- 
tion or  electric  charge?  Or  if  the  organ  be  over-active  what 
difference  whether  the  inhibitory  effect  be  produced  by  one  or 
by  another? 

If  an  excess  of  acid  be  present  in  the  stomach  is  it  the 
acid  that  is  at  fault  that  the  drug  giver  should  attempt  to 
neutralize  it  by  an  alkali ;  or  is  it  the  fault  of  the  gland  in 
being  over-active  that  it  should  be  quieted;  or  are  the  digest- 
ive forces  derelict  to  duty  that  they  should  be  whipped  into 
normal  activity  by  water,  or  by  mechanical  pressure,  or  by 
electric  touch?  These  measures  can  at  most  be  but  temporary. 
The  acidity,  from  whatever  cause,  will  not  be  present  except 
the  instrument  through  which  the  digestive  processes  are 
performed  be  interfered  with.  The  only  essential  in  the  treat- 
ment is  to  remove  the  interference  to  those  processes  which 
normally  provide  the  neutralizing  substances,  or  better,  to 
relieve  the  condition  which  causes  the  necessity  for  a  neutral- 
izing substance. 

And  why  attempt  to  substitute,  whether  it  be  a  drug  as 
iron  for  anemia,  or  a  force  as  an  electric  current  in  nerve  ex- 
haustion, when  all  such  necessary  substances  and  forces  are 


COMPARISON   WITH   OTHER   SYSTEMS.  193 

present  potentially  in  the  food  materials?  Rather  remove 
the  impediment  to  the  assimilation  processes  which  prevents 
the  normal  conversion  of  that  potential  into  a  kinetic  mani- 
festation. 

In  like  manner,  why  be  satisfied  with  attempts,  which' 
can  never  be  entirely  successful,  to  destroy  the  micro- 
organism? The  body,  by  virtue  of  its  white  corpuscle,  its 
alkalinity  and  its  special  acid  substances,  its  nucleins  and  its 
alexins  of  the  blood,  and  its  numerous  superficial  structures 
and  substances,  is  already  thoroughly  protected  except  when 
its  nutritive  condition  is  below  par  due  to  disorder  of  its  me- 
chanism. Rather  it  is  the  part  of  wisdom  to  attend  to  the  struc  - 
tural  condition  of  the  organism  which  will  permit  or  compel 
a  normal  function. 

Fundamentally  then  the  difference  is  an  absolute  one. 
The  distinct  and  peculiar  position  of  the  osteopath  as  an  ad- 
vocate of  a  new  system  lies  in  his  contention  that  disease  is 
caused  or  maintained  by  structural  disorder,  the  re- 
moval of  which  constitutes,  the  treatment.  If  the  liver  be- 
comes disarranged  the  drug  therapist  administers  a  chola- 
gogue;  the  electrotherapist  introduces  an  electric  stimulant; 
the  hydrotherapist  applies  water ;  the  mental  healer  removes 
hindering  mental  conditions;  the  mechanotherapist  com- 
presses and  stimulates  by  mechanical  means;  while  the  os- 
teopath removes  the  hindering  structural  condition  which 
prevents  normal  nutrition  and  hence  restoration  of  normal 
metabolism. 


194  PRINCIPLES   OF   OSTEOPATHY. 


PA  RT    I  I  . 


CHAPTER  X. 


THE  SPINE. 
GENERAL  SURVEY. 

Because  of  the  fact  that  the  spine  is  of  such  fundamental 
importance  to  the  osteopath  a  brief  general  survey  of  its 
structure  and  relationships  will  be  given  before  taking  up  sepa- 
rate divisions  for  specific  'study.  That  the  spine  is  of  such 
importance  is  recognized  by  every  practitioner,  for  it  is  only 
in  occasional  cases  of  disease  that  no  treatment  is  given  to 
it,  while  almost  invariably  regardless  of  the  nature  of  the 
symptoms  presented,  the  careful  osteopath  will  make  a  study 
of  its  various  parts  in  the  process  of  diagnosis. 

With  reference  to  the  general  contour  of  the  spine  a 
few  points  should  be  noted :  The  normal  curves  are  four  in 
number,  two  of  which  may  be  considered  primary,  the  others 
secondary  and  compensatory.  During  fetal  life  and  to  the 
second  year  of  infancy  the  anterior  curvatures  are  not  mark- 
edly developed — indeed  during  intra-uterine  life  the  spinal 
column  constitutes  the  arc  of  a  circle  while  in  infancy  it  is 
comparatively  straight.  As  the  child  assumes  the  erect  pos- 
ture the  anterior  curvatures  become  developed,  that  develop- 
ment being  necessary  for  purposes  of  equlibrium.  The  tho- 
racic and  the  pelvic  curvatures  are  physiological  in  the  sense 
of  forming  a  cavity  for  the  protection  of  various  viscera.  In 
addition  to  this  advantage  there  is  the  equally  important  one 
of  providing  against  the  shock  to  the  body  generally  and  to 
the  brain  especially  that  would  otherwise  occur  at  every  jar 
or  even  footfall,  the  column  in  this  way  performing  the  office 
of  a  mechanical  spring.  In  noting  the  anterior  and  posterior 
curvatures  the  fact  should  be  remembered  that  a  vertical  line 


THE    SPINE.  195 

cutting  the  tips  of  the  spinous  processes  of  the  verterbrce  is  not 
parallel  with  the  longitudinal  aris  of.  the  spinal  column  taken  as  a 
whole,  this  fact  being  dependent  upon  the  difference  in  obli- 
quity existing  between  the  spinous  processes  of  the  various 
regions;  for  instance  in  the  raid -thoracic  region  owing  to  the 
extreme  obliquity  of  the  spinous  processes  a  line  passing 
through  these  will  approach  much  more  closely  the  spinal 
axis  than  it  would  in  the  lumbar  region.  Hence,  a  spine  ap- 
pearing perfectly  straight  as  judged  by  the  row  of  spinous 
processes  will  not  be  so  in  reality.  In  making  judgment  with 
respect  to  the  prominence  or  otherwise  of  the  various  curves 
the  transverse  processes  should  be  noted,  to  correct  errors 
arising  from  consideration  of  the  spines  alone.  A  spine 
which  has  in  reality  had  its  curves  obliterated  is  technically 
spoken  of  as  a  straight  spine  and  will  often  be  associated  with 
the  so-called  [smooth  spine,  a  term  which  has  come  into  use  as 
representing  a  condition  in  which  the  connecting  structures 
between  adjacent  processes  have  become  thickened  and  in 
numerous  cases  contracted,  giving  it  undue  rigidity.  The 
smoothness  is  not  necessarily  indicative  of  a  state  of  lesion, 
for  it  may  be  a  simple  filling  in  of  normal  tissue,  but  the  rigid- 
ity in  most  cases  is  evidence  of  a  lesion. 

The  rigid  spine  depends  upon  one  or  more  of  several 
pathological  changes.  It  may  be  due  simply  to  muscle  con- 
tracture  in  which  case  the  rigidity  will  temporarily  yield  to  a 
relaxing  treatment;  it  may  be  dependent  on  overgrown  and 
contracted  ligamentous  tissues  resulting  from  irritation,  conges- 
tion, or  inflammation  of  those  structures;  in  some  cases  it  is 
due  to  structural  alterations  in  the  articular  and  interverte- 
bral  cartilages  from  erosions  or  deposits;  while  in  extreme 
cases  when  associated  with  a  former  inflammatory  lesion,  it 
is  due  to  bony  ankylo sis,  in  which  the  diagnostician  will  not  be 
able  to  detect  any  movement  between  adjacent  vertebrae.  In 
considering  the  case  of  the  rigid  spine  the  fact  should  be  re- 
membered that  with  increasing  age  there  will  normally  be  in- 
creasing rigidity. 


196  PRINCIPLES    OF   OSTEOPATHY. 

Cases  are  met  with  considerable  frequency  presenting 
the  opposite  condition  to  .  the  above,  in  which  the  laxity  of 
the  spinal  column  is  quite  apparent.  This  will  be  equally 
noticeable  whether  the  patient  is  in  the  erect  or  horizontal 
posture.  In  the  former,  movement  of  the  part  is  free  and  ex- 
treme and  the  patient  will  seem  to  be  unable  to  hold  the  spine 
erect  for  any  appreciable  length  of  time;  in  the  latter  if  he 
lies  upon  ttie  side  a  lateral  curvature  will  seem  to  be  present 
with  the  convexity  below,  this  appearance  being  due  to  the 
weight  of  the  body  upon  the  yielding  column.  Such  cases 
are  usually  the  result  of  a  chronic  condition  in  which  nerve 
force  and  blood  conditions  have  become  altered;  in  many 
cases  it  simply  represents  a  stage  secondary  to  a  former 
rigidity  dependent  upon  muscle  and  ligamentous  contracture. 
Lateral  curvatures  are  among  the  more  common 
lesions  and  are  usually  double,  i.  e. ,  if  a  primary  curva- 
ture is  present  in  the  upper  or  middle  thoracic  toward  the  left, 
there  will  be  a  secondary  or  compensatory  right  lateral  curva- 
ture in  the  lumbar  region.  This  will  be  true  of  practically  all 
lateral  curvatures  of  any  considerable  degree  of  development, 
the  compensatory  condition  developing  in  the 
same  way  and  for  the  same  purpose  as  those 
of  the  antero-posterior  type,  i.  e. ,  for  pur- 
poses of  maintaining  equilibrium.  With  refer- 
ence to  the  lateral  curvature  it  should  be  noted 
that  it  is  again  true  that  the  extent  of  the  cur- 
vature of  the  spine  taken  as  a  whole  may  not  be 
correctly  represented  by  the  line  of  spinous  pro- 
cesses^ for  with  many  cases  of  lateral  curva- 
ture there  will  be  a  rotation  of  the  vertebra 
upon  its  vertical  axis  in  such  a  manner  as  to 
Fig.  9.— NO.  i JB  cause  a  greater  lateral  drift  of  the  body  of  the 

in    more    stable 

equilibrium  than  bone   than   of  its   spine.     The   cause   of  this 

No.     2.       Hence 

compensatory  peculiarity  need  not  be   here   detailed   except 
curvature    IB*  r 

physiological.       to  indicate     that    it  is   dependent   upon  the 

peculiar  relations  of  the  articular  processes  and  the  direction 


THE   SPINE. 


19T 


of  the  tension  exerted  by  the  muscles  with  reference  to  the 
leverages  presented.  The  diagnosis  will  be  determined  by  the 
line  of  spinous  processes,  the  line  and  prominence  of  the 
transverse  processes,  the  difference  in  the  prominence  of  the 
angles  of  the  ribs  on  the  two  sides,  together  with  the  carriage 
and  attitude  of  the  patient  and  individual  peculiarities  associ- 
ated with  each  case. 

For  the   purpose  of  determining  the  condition   of   any 
single  vertebra,  both  the  spinous  and  transverse  processes 

must  be  examined. 
Of  the  two  the  trans- 
verse will  be  asso- 
ciated with  less  pos- 
sibility of  error  be- 
cause of  two  fads 
namely :  they  are 
less  subject  to  caus- 
es compelling  ab- 
normal growth  con- 
ditions and  hence 
will  vary  less  from 
the  typical  shape 
and,  second,  the 
pair  affords  oppor- 
tunity for  compari- 
son. The  spinous 
processes  are  the 
more  easily  reached 
and  are  of  advan- 
tage because  of  that 
fact.  In  noting  the 
relative  position  of 
the  fingers 
be  rapidly 
down  over 


Fitf.  10. — Approximation  between  8th  and  9th  and 
separation  between  llth  and   12th  thoracic  spines. 


spines 
may 
drawn 


them  or  on  either  side,  in  this  way  tending  to  produce  flush- 


198  PRINCIPLES   OF  OSTEOPATHY. 

ing  or  pallor  of  the  skin  overlying  them,  in  which  condi- 
tion they  may  be  compared  with  each  other.  Or  in  the  rapid 
passing  of  the  hand  the  muscular  sense  will  suggest  any 
slight  swerves  or  deviation  not  noticeable  on  first  inspection. 
Separations  between  spinous  processes  suggests  a  weakness 
dependent  on  overstretched  ligaments.  In  most  cases  the 
condition  is  not  a  separation  of  the  vertebrae  as  a  whole  but 
a  separation  of  the  posterior  aspects  with  a  corresponding 
approximation  of  the  anterior  parts,  i.  e.,  the  bodies.  In  the  lax 
spine,  where  a  large  area  is  involved,  it  is  likely  to  be  a  real 
separation  of  the  vertebrae  as  a  whole,  and  dependent  on  a 
generally  stretched  condition  of  all  the  connecting  struc- 
tures. On  the  other  hand  two  adjacent  spines  may  seem  to 
be  unduly  approximated.  This  may  be  due  to  one  or  both  of 
the  opposite  conditions,  i.  e.,  tightening  and  shortening  of 
the  ligamentous  tissues  posteriorly  or  throughout.  Anterior 
subluxations  will  seldom  be  determined  by  reference  to  the 
spinous  process  alone  but  will  be  noted  on  comparison 
of  the  transverse  processes  with  those  above  and  be- 
low. The  same  is  true  with  regard  to  the  posterior,  lateral, 
and  twisted  conditions.  Perhaps  the  most  common  type  of 
subluxation  of  a  local  part  is  the  torsion  or  twisting  of  the 
column  at  the  junction  of  two  adjacent  vertebras.  Note  that 
the  total  torsion  possibility  of  the  spine  in  normal  conditions  is 
about  100  degrees. — (Holden).  In  the  cervical  region,  the 
sacro-lumbar  junction,  and  the  dorso-lumbar  articulation, 
most  of  the  rotation  is  normally  produced.  In  other  parts 
there  is  present  some  turning  while  under  the  abnormal  cir- 
cumstances sufficient  may  be  present  to  be  easily  detected. 
This  will  be  possible  by  reference  to  the  position  of  the  spin- 
ous process,  the  transverse  processes,  and  the  angle  of  the 
associated  rib.  In  lateral  subluxations  of  single  vertebrae,  not 
only  the  spinous  process  but  the  transverse  will  be  out  of  line 
with  those  adjacent,  and  the  angle  of  the  rib  on  the  side  to- 
ward which  the  part  is  displaced  will  be  prominent.  Many 
conditions  diagnosed  as  lateral  will  on  closer  analysis  be 


THE   SPINE.  199 

found  to  be   a  torsion.     Hence   the  necessity  to  take  note  of 
as  many  of  the  points  of  prominence  as  present  themselves. 

To  determine   the  serial  number  of  the  particular  ver- 
tebra   disordered,    a  few   facts   may  be  helpful.     The  second 
cervical  is  the  first  spinous  process  noted  on  superficial  exam  • 
ination.     It  is  prominent,  bifid,  and  quite  subject  to  variation 
in  size  as  well  as  in  relative  development  of  its  two  tubercles. 
The  bifid  condition  may  not  be  noticeable  to  the  amateur  ex- 
cept on  careful  palpation.     The  third,  foiirth,  and  fifth  spines 
recede  anteriorly  in  the  erect  position  but  may  easily  be  noted 
when   the  patient  is   supine  and   completely   relaxed.     The 
last  cervical  and  first  thoracic  on   account  of   their  prominence 
are  easily  detected.     The  last  cervical  may  be  distinguished 
by  noticing  the   sixth   whose  spinous   process   usually   rests 
upon  that  of   the  seventh   in  a  saddle-like  manner,  and  will 
often  be  felt   as   a  tubercle  upon  the  spine  of  the  latter  a  few 
millimeters    from    its    tip.     The    typical  spines  through    the 
thoracic    region  will  be  on  a  level  with  the  transverse  processes  of 
the  vertebra  next  below,  hence  the  level  of  the  spine  is  not  neces- 
sarily nor  usually  the   level  of  the  more  important  part  of  the 
lesion.     The  inferior   angle   of  the  scapula  is  on  a  level  with 
the  spine  of  the  seventh  thoracic.     The   spine,  transverse  pro- 
cesses, and  spinal  end  of   twelfth  rib  are  on  a  level  at  the  last 
thoracic.     Also,  there  is   usually  a  more  marked  separation  of 
spines  at  the  junction  of  the  lumbar  and  thoracic  regions  than 
above  or  below.     The  level  of  the  fourth  lumbar  is  the  level  of 
the  superior  part  of  the  innominata.     The  lumbo-sacral  junc- 
tion is  noted  for  its   separation  of  spines  and  its  greater  mo- 
bility.    This  latter  point  may   be  essential  to  note  in  some 
cases  where  the  first  sacral  spinous  process  is  prominent.     Do 
not  be  misled  in   reference  to  this  junction.     Often   the  fifth 
lumbar  is  anterior  but  more  often  it  is  a   dipping   forward  of 
the  articulation  due  to  some  weakness  of  the  anterior  or  dis- 
proportionate strength  of  the  posterior  ligaments  in  which  the 
process  may  not  be  as  prominent  as  it  normally  is.     Further, 
this  is  a  region  of  wide  normal  variations  and   the  abnormal 


200 


PRINCIPLES   OF   OSTEOPATHY. 


condition  may  be  more  apparent  than  real.  Emphasis  should 
be  laid  on  the  following  with  reference  to  the  general  survey 
of  the  spine. 

1.  Examine  in  more  than  one  position. 

2.  Take  note  of  other  points  than  mere  displacement 
of  parts,  i.  e.,  soreness,  contractures,  and  others  to  which  at- 
tention has  been  called. 

3.  Inquire  as  to  the  relative  use  of  the  two  sides,  i.  e., 
whether  "right  handed"  or  otherwise.     Dr.  Still  calls  atten- 
tion  to   the   fact  that   all  the  bony  prominences  will  be  more 
prominent  on  the  side  most  largely  used.     In   many  cases  a 
slight  curvature  is  noticed  toward  the  side  of  greater  develop- 
ment. 

4.  The  row  of  spinous  processes  marks  the  middle  line 
of  a  distinct  median  furrow,  the  regularity  of  which  is  a 
valuable  general  point  in  the  diagnosis.     This  median  furrow 
will  be  most  noticeable  in  the   dorso- lumbar  region  where  its 

boundaries  are  composed  of  the  muscle 
mass  associated  with  the  erector  spinae 
system. 

5.  Tenderness  is  usually  more 
noticed  on  the  side  toward  which  the 
subluxation  was  produced.  But  in  most 
cases  where  present  at  all  it  will  be  no- 
ticed at  all  parts.  Bending  the  head  for- 
ward and  downward  strongly  will  often 
cause  pain  at  the  point  of  lesion  that 
otherwise  would  not  be  detected ;  this  by 
virtue  of  the  fact  that  the  ligamentum 
nuchae,  continued  throughout  the  spine 
by  the  supra- spinous  ligaments,  exerts 
an  upward  and  outward  tension  on  the 
spinous  processes  which  pass  obliquely 
downward  and  outward.  Pressure  on  the 

Fig.  11.— Showing  effect  on    ...  ,          ,         ...        ,.    ,  ,  ,. 

vertebral  spines  of  flexion  head  downward  and   with  slight  rotation 
will  produce  pain  at  the  point  of  lesion. 


of  head. 


UBF/RY  OF 
COLLEGE  fj 

p  [J  •/•  c  [  r  f  f  f  f  r 
THE   SPINE.  201 

This  is  notably   true  of  inflammatory  conditions  such  as  are 
present  in  Pott's  disease. 

6.  Usually  muscle  contracture  will  be  easily  detect- 
ed as  an  associated  lesion.     In  most  cases  this  will  locate  the 
deeper  bony  and  ligamentous  distortion.    Care  must  be  taken 
to   distinguish   between  a  real  contracture  and  a  condition  of 
tissue  adjustment  to  the  existing-  deeper  lesion,  for  in  many 
cases  prominences  will  be  noted  which  are  not  at  all  due  to  a 
pathological   condition   of   the  muscle  itself.     On  the  convex 
side  of   a   curvature   there   will   often  be  greater  superficial 
prominence  while  the  actual  contracture  will  be  on   the   side 
of  the  concavity. 

7.  Note  the  sounds   produced   by  movement  of  parts. 
These  are  more  noticed  in  the  cervical  part  of  the  spine   and 
the   costo- vertebral   articulations.      They  depend    on,   first, 
friction  of  ligaments  or  articulations  due  to   lack   of  lubrica- 
tion ;    second,   the  same  cause  which  operates  to  produce  the 
snapping  of  the  phalange -metacarpal  junctions  on  extension 
of  the   fingers,   the  "breaking  of  the  current"  suggested  by 
Dr.  Still;  third,  adjustment  of  displaced  structures.      In   most 
cases  little  importance  is  to  be  attached  to  the  sounds  unless 
unduly  prominent  for  they  can  be  produced   in   most  normal 
individuals. 

8.  The.  average  lesion  is   slight  in  extent.     It  seems 
necessary  to  emphasize  this  fact   continually  because  of  the 
assumption  on  the   part  of  the  beginner  that  every  lesion  is 
comparable  to  a  hip  dislocation.     In  one  sense  this  is  true- 
that  is,  in  so  far  as  it  is  a  change  in  position  of  the  involved 
parts,  but  in  most  cases  the  displacement  will  be  measured  in 
millimeters  rather  than  inches.     This  does  not  of  course  mean 
that  the  effect  produced  will  be  slight.     Further,  in   noticing 
the   prominence  in   the  case  of  a  lesion  it  should  be  remem- 
bered that  the  projection  is  not  due  simply  to  the  bone  but  to  the 
overlying  softer  tissues;  for  where  the  bone  is  displaced  the  tis- 
sue against  which  it  is  forced  must  of  necessity  suffer  irrita- 
tion with  a  resulting  condition  of  contracture  or  enlargement 


>:;  :: ;  i .;  i  0  i  c-  >  H  S 

202  PRINCIPLES   OF  OSTEOPATHY. 

from  congestion  and  inflammation  with  infiltration,  or  finally 
of  overgrowth.  But  there  are  exceptions  in  which  a  lesion 
of  a  single  vertebra  may  be  so  marked  that  it  would  not  be  far 
from  wrong  to  speak  of  it  in  terms  of  at  least  quarter  inches. 
Such  will  either  be  complete  dislocations  suddenly  produced, 
which  are  rare,  or  deviations  gradually  produced  in  which 
the  bony  and  ligamentous  growth  has  been  sufficiently 
changed  to  allow  of  the  displacement.  That  such  a  condition 
is  occasionally  met  with  will  be  agreed  to  by  all  osteopaths, 
and  that  it  is  possible  is  reasonable  from  the  fact  that  the 
molecules  of  a  block  of  granite  may  be  gradually  changed  by 
sufficient  pressure  acting  continuously.  The  gradual  change 
of  living  bone  under  a  muscle  or  other  continuously  acting 
force  is  much  more  reasonable  and  is  known  to  occur. 

GENERAL  AND  SPECIFIC  EFFECTS  OF  SPINAL  LESIONS. 

A  discussion  of  the  manner  in  which  the  spinal   lesion 

produces  the  disorder  of  function  will  represent  the  entire 
field,  hence  we  shall  speak  at  length  of  the  immediate  and 
remote  results  possible  from  such  condition  together  with  a 
consideration  of  those  anatomical  and  physiological  facts 
which  tend  to  throw  light  upon  the  manner  in  which  the  lesion 
involves  the  organ  in  disorder.  The  fundamental  considera- 
tion will  be  the  anatomical  relationships  between  the  tissue 
acting  as  lesion  and  the  structure — artery,  nerve,  or  other 
part — acted  upon  by  the  lesion.  Hence  a  recapitulation  of 
certain  known  but  little  emphasized  structural  conditions  will 
be  given. 

Note  that  the  entire  field  is  covered.  The  spinal  lesion 
may  involve  the  organ  by  direct  pressure ,  by  impingement  on 
artery,  vein,  lymphatic  or  nerve.  In  the  cervical  region  the  fol- 
lowing will  be  involved :  vertebral, intervertebral,  cartoid,  and 
thyroid  arteries  and  corresponding  veins  and  lymphatics; 
the  fifth,  seventh,  ninth,  tenth,  eleventh,  and  twelfth  cranial, 
the  eight  pair  of  spinal,  and  the  sympathetic  nerves;  direct 
pressure  upon  structures  from  an  anterior  condition  of  the 


THE   SPINE.  203 

cervical  spine  as  a  whole.  In  the  thoracic  region  there  will  be 
direct  pressure  by  crowding  from  an  anterior  displacement 
of  the  spine;  pressure  on  cervico-thoracic,  intercostal,  and 
intervertebral  vessels;  the  twelve  spinal  and  the  numerous 
parts  of  the  thoracic  sympathetic  nerves.  In  the  lumbar  por- 
tion impingement  will  be  made  on  lumbar  and  intervertebral 
vessels  and  the  spinal  and  sympathetic  nerves.  In  the  pelvic 
spine,  sacral  nerves,  both  spinal  and  sympathetic,  and  vascu- 
lar branches  will  be  affected,  while  the  coccyx  by  its  anterior 
distortion  will  directly  involve  the  rectum  and  associated 
structures. 

In  all  of  these  situations  the  method  of  impingement  and 
the  explanation  of  results  will  in  general  be  the  same,  and 
hence  only  general  considerations  will  be  given,  reserving 
the  details  for  those  sections  dealing  with  the  discussion  of 
the  several  divisions  of  the  spine  and  body. 

A  TYPICAL  CONDITION. 

One  of  the  most  common  lesions  with  which  the  osteo- 
path meets  is  torsion,  or  a  twisted  condition  between  two 
adjacent  vertebrae.  What  will  be  the  effect  on  the  typical 
articulation?  There  are  three  body  ligaments,  anterior,  pos- 
terior, and  intervertebral  substance;  two  lateral  yellow  elastic 
ligaments  connecting  the  laminae;  two  articular  structures 
with  their  typical  parts;  two  spinous  ligaments,  the  supra- 
spinous  and  intra-spinous;  and  two  inter-transverse  ligaments. 
In  addition  to  this  typical  ligamentous  material  there  is  pres- 
ent the  muscular  slips  of  the  deep  layers  of  the  spine,  and  all 
the  space  being  filled  up  by  supporting  connective  tissues.  With 
the  torsion  condition  present  all  of  these  various  structures 
will  be  put  upon  the  stretch  as  well  as  suffering  greater  or  less 
change  in  sitiiation.  Into  and  out  of  the  spinal  canal  pass  the 
following  structures  by  way  of  the  intervertebral  foramen:  the 
arterial  branch  coming  off  from  the  intercostal  to  pass  within 
the  spinal  canal  and  aid  in  the  supply  of  the  spinal  cord;  the 
intervertebral  vein  or  plexus  carrying  waste  material  from 


204  PRINCIPLES   OF  OSTEOPATHY. 

the  same  region ;  lymphatic  vessels  and  spaces  concerned 
with  the  nutrition  of  the  same  part;  the  spinal  nerve  made  up 
of  the  junction  of  its  roots,  which  occurs  just  within  the  fora- 
menj  branches,  many  in  number,  from  the  various  parts  of 
the  cerebro- spinal  and  the  sympathetic  nervous  system. 

First,  the  artery  may  be  impinged,  not  necessarily  by 
the  bony  prominences  but  by  the  ligamentous  and  connective 
tissue  tension  and  the  general  crowding  resulting  therefrom, 
and  from  an  associated  congestion  and  infiltration  due  to  the 
original  strain  or  displacement.  The  pressure  upon  the  artery, 
if  efficient,  will  produce  in  the  part  to  which  it  is  distributed, 
i.  e.,  the  spinal  cord  and  other  canal  structures,  a  condition 
of  ischcemia.  This  condition  must  of  necessity  produce  greater 
or  less  disturbance  of  the  metabolism  of  the  cells  in  the  spinal 
cord  with  a  consequent  disorganization  oftlie  impulses  received  and 
distributed  therefrom-  for  while  the  axis  cylinder  process  is  not 
appreciably  subject  to  fatigue,  undergoing  little  katabolism 
and  hence  requiring  little  nutriment  direct  from  the  blood 
stream,  the  cell  bodies  are 'very  susceptible  to  the  changes  in 
the  quality  and  quantity  of  their  food  supplies.  In  this  con- 
nection the  physiological  fact  should  be  noted  that  the  outgo- 
ing impulse  from  a  nerve  center  is  not  the  simple  continuation  of  an 
impulse  receivedfrom  an  afferent  pathway,  but  depends  directly 
upon  changes,  chemical  and  vital,  brought  about  in  various 
ways  within  the  cell  body  protoplasm.  Hence  the  ischaemic 
condition  of  the  spinal  cord,  by  deranging  and  limiting  the 
metabolism  of  this  cell  protoplasm,  will  very  materially  in- 
terfere with  normal  nerve  discharge.  It  is  possible  that  if  the 
pressure  upon  the  artery  is  sufficiently  long  continued  and 
irritating,  a  hypercemic  condition  may  result.  This  would  de- 
pend upon  the  gradual  exhaustion  of  the  tissues  in  the  wall  of 
the  artery  with  the  resulting  lax  condition  permitting  vascu- 
lar dilatation. 

The  vein  or  venous  plexus  which  drains  the  local  spinal 
area  will  be  more  yielding  to  pressure  than  the  artery  because 
of  the  less  rigid  nature  of  the  venous  wall.  Hence  with  the 


THE   SPINE.  205 

ischsemic  condition  produced  by  pressure  on  the  artery  there 
will  be  associated  a  venous  hyperaemia,  which,  other  things 
being  equal,  will  likely  be  more  serious  than  the  former.  This 
is  due  to  the  fact  that  the  venous  blood  contains  material  of  a 
nature  ultimately  toxic  to  the  tissues  and  continually  becom- 
ing more  so  the  longer  it  is  retained  in  a  part.  With  such  a 
condition  present  in  the  spinal  cord  a  preliminary  ex  cited  con- 
dition of  the  cells  will  be  probable  owing  to  the  chemical 
structures  of  the  acid  and  other  materials  in  the  venous  blood 
acting  upon  them,  but  a  later  and  more  permanent  condition 
of  inhibition  of  impulses  will  result  owing  to  the  depressant 
effect  of  the  prolonged  presence  of  the  toxic  material. 

The  lymphatic  system  may  be  more  or  less  impaired 
by  the  same  pressure  conditions.  This  naturally  would  re- 
sult in  the  same  general  disorders  of  nutrition  found  in  the 
arterial  disturbance.  The  lymph  being  the  medium  from 
which  the  tissues  directly  get  their  nutriment,  the  necessity 
for  freedom  of  that  system  becomes  apparent.  These  three 
structures,  artery,  vein,  and  lymphatic,  are  so  closely  asso- 
ciated in  their  functioning  capacities  and  in  their  anatomical 
relationships  that  the  lesion  affecting  one  will  affect  the  other, 
and  the  resulting  disorder  will  be  practically  the  same  in  each 
case. 

The  spinal  nerve  may  be  impinged  upon  by  the  same 
general  crowded  condition  of  affairs  but  owing  to  the  fact  that 
its  nerve  sheath  is  comparatively  strong  and  unyielding  it  is 
less  likely  to  suffer  thus  directly  than  are  the  other  structures 
mentioned.  Pressure  may  in  some  cases  cause  sufficient 
irritation  of  the  nerve  terminals  within  the  sheath,  i.  e.,  the 
nervi-nervorum,  or  of  the  axis  cylinders  proper,  to  produce 
disorder  in  the  parts  to  which  the  nerve  is  distributed.  Hence 
conditions  of  a  motor  and  sensory  nature  may  result ;  muscular 
contractures  of  nearby  or  remote  tissue  and  neuralgic  and 
other  disorders  of  sensation  are  common.  In  addition  to 
these  disturbances  which  have  reference  to  the  special  func- 
tion of  the  spinal  nerve  disorders  of  the  sympathetic  may  re- 


206  PRINCIPLES   OF   OSTEOPATHY. 

suit  from  the  fact  that  practically  all  spinal  nerves  carry  with 
them  fibres  derived  from  the  sympathetic.  It  is  suggestive  to  note 
the  fact  that  in  locomotor  ataxia  degenerative  changes  in  the 
peripheral  afferent  system  constitute  the  morbid  anatomy,  the 
degeneration  according  to  some  authorities  beginning  in  the 
cell  bodies  in  the  ganglion  on  the  posterior  nerve  root,  this 
ganglion  being  closely  related  anatomically  to  the  inter  vertebral 
foramen  and  its  associated  structures  and  hence  reasonably  sub- 
ject to  lesion. 

The  sympathetic  system  may  be  involved  by  the  lesion, 
and  all  things  considered,  is  without  doubt  the  most  subject 
to  interference  by  any  of  the  forms  of  spinal  lesion.  Owing 
to  its  paramount  importance  in  osteopathic  reasoning  and  to 
the  further  fact  that  its  anatomical  and  physiological  relation- 
ships have  not  been  sufficiently  emphasized  by  the  old  school 
authorities,  and  because  it  is  difficult  for  the  average  student 
to  understand,  a  general  survey  of  the  entire  system  will  be 
given,  indicating  the  more  important  details. 

THE  SYMPATHETIC  SYSTEM. 

Fundamentally  there  is  no  distinction  between  the  sympathetic 
and  the  cerebro-spinal  systems.  Under  normal  conditions  the 
former  is  but  an  outgrowth  from  the  latter  during  the  earlier 
weeks  of  fetal  life.  At  that  period  of  the  life  of  the  embryo 
when  a  vertical  section  shows  the  medullary  groove  well  de- 
veloped and  the  walls  of  which  represent  the  ectodermal  cells 
which  give  rise  to  the  nerve  cell  bodies  of  the  spinal  cord  and 
brain,  on  either  side  toward  the  upper  aspect  of  the  groove 
and  later  the  canal  there  will  be  noticed  a  ridge  of  this  origi- 
nal nerve  cell  tissue.  This  ridge  eventually  becomes  separ- 
ated from  the  other  part  and,  dividing  into  groups,  develops 
into  the  ganglia  of  the  posterior  spinal  nerve  roots.  As  outbuddings 
from  this  ridge  a  little  later  will  be  noted  a  series  of  clumps 
of  cells,  most  of  which  becoming  separate  from  the  original 
ridge,  form  the  series  of  sympathetic  ganglia  which  are  known 
in  the  developed  state  as  the  gangliated  cord  of  the  sympa- 


THE   SPINE.  207 

thetic,  but  some  of  which  in  the  form  of  migrating  cells  pass 
outward  to  various  parts  of  the  growing  embryo  and  ultimate- 
ly develop  into  the  ganglia  of  the  sympathetic  plexuses  and  in- 
trinsic ganglia  of  the  viscera.  These  several  clumps  of  cella 
with  their  outgrowing  axis  cylinder  processes  should  logically 
alone  comprise  all  of  the  sympathetic  system.  What  is  usually 
included  are  the  double  row  of  connected  ganglia  one  on  either 
side  of  the  spinal  column,  the  fibers  passing  to  and  from  these 
ganglia  making  connection  on  the  one  hand  with  the  spinal 
nerves  through  the  rami  communicantes  and  on  the  other  with 
the  various  prevertebral  plexuses  formed  largely  by  branches 
received  from  the  gangliated  cord  and  containing  a  few  cell 
bodies,  and  the  final  distributing  filaments  from  these  plexuses 
to  the  various  viscera. 

With  regard  to  the  gangliated  cords,  four  divisions 
are  spoken  of.  The  cervical  portion  consists  of  the  three  ganglia 
with  their  connecting  cords,  and  lies  at  the  side  of  the  bodies 
of  the  vertebrae  behind  the  carotid  sheath  in  the  connective  tis- 
sue and  in  front  of  the  transverse  processes  from  which  they  are 
separated  by  muscular  and  connective  tissue.  The  thoracic 
portion  consisting  of  eleven  or  twelve  ganglia  with  their  con- 
necting cords  lies  in  front  of  the  heads  of  the  ribs  in  the  areolar 
and  other  tissue  lying  behind  the  pleurae.  The  lumbar  portion 
consisting  usually  of  four  ganglia  lies  to  the  inner  side  of  the 
psoas  muscle  on  the  antero- lateral  aspect  of  the  vertebral 
bodies  behind  the  large  abdominal  vessels.  The  sacral  portion 
consisting  of  the  four  ganglia  lies  to  the  inner  side  of  the  row 
of  sacral  foramina  in  the  connective  tissue  separating  the  pelvic 
organs  from  the  sacrum.  The  cords  in  this  region  converge 
to  form  the  ganglion  impar  lying  in  front  of  the  coccyx,  in  a 
way  similar  to  the  formation  of  the  ganglion  ofEibes  situated  on 
the  anterior  communicating  artery  in  the  cranial  cavity.  In 
all  of  these  regions  the  ganglia  themselves,  and  less  probably 
their  connecting  cords,  are  more  or  less  subject  to  pressure 
from  associated  structures. 

The  plexuses  are  numerous   and   are   associated   with 


208  PRINCIPLES   OF  OSTEOPATHY. 

practically  every  viscus  of  the  body.  The  cardiac  made  up 
from  branches  of  the  cervical  ganglia  is  situated  in  close  re- 
lation to  the  upper  part  of  the  heart  and  the  arch  of  the  aorta, 
and  will  be  subject  to  lesion  directly  by  abnormal  conditions 
of  the  thoracic  organs.  The  pulmonary  plexus  made  up  from 
branches  received  from  the  upper  thoracic  ganglia  and  a  few 
fibres  from  the  cardiac  plexus,  lies  on  the  root  of  the  lung,  and 
will  be  subject  to  lesion  in  a  manner  similar  to  that  of  the 
cardiac.  The  solar  plexus  is  the  largest  in  the  body  and  gives 
off  fibres  that  make  up  the  individual  plexuses  associated  with 
most  of  the  abdominal  organs.  This  plexus  is  derived  fron 
branches  from  the  thoracic  ganglia  forming  the  three  splanch- 
nic nerves,  and  lies  upon  the  spinal  column  at  the  second 
lumbar  and  in  front  of  and  associated  with  the  great  vessels. 
It  is  subject  to  lesion  by  direct  pressure  from  abdominal 
tumors,  displaced  viscera,  impacted  feces,  and  the  like.  Cords 
passing  down  from  this  plexus  and  re-inforced  by  fibres  from 
the  lower  thoracic  and  lumbar  ganglia  make  up  the  abdomi- 
nal aortic  plexus.  The  hypogastric  plexus  continued  from  the 
aortic  and  re-inforced  by  fibres  from  the  lumbar  and  sacral 
ganglia,  lies  between  the  two  common  iliac  arteries  upon  the 
last  lumbar  body  and  the  promontory  of  the  sacrum,  within 
the  meshes  of  a  dense  connective  tissue  material.  The  tightening 
of  this  connective  tissue,  the  general  ptosis  condition  of  the 
abdominal  organs,  or  tumor  and  pregnant  states  may  involve 
the  plexus  in  disorder.  From  the  lower  part  of  the  hypo- 
gastric  plexus  fibres  are  given  off  to  either  side  of  the  cavity 
of  the  pelvis  where  they  form  the  pelvic  or  inferior  hypogastric 
plexuses.  Throughout,  these  various  plexuses  are  further 
added  to  by  branches  from  some  of  the  cranial  or  spinal 
nerves. 

The  connection  between  the  sympathetic  ganglia  and 
the  central  system  is  equally  complex  and  important.  The 
rami  communicantes  are  usually  considered  a  part  of  the  sym- 
pathetic system  although  the  white  ramus  is  in  reality  a  part 
of  the  central  system.  These  communicating  structures  con- 


THE   SPINE.  209 

<nect  the  ganglion  and  the  anterior  primary  division  of  the 
spinal  nerve.  They  get  their  names  from  their  appearance 
which  is  due  to  medullary  sheaths  in  the  fibres  of  the  white 
ramus  and  the  absence  of  that  sheath  in  the  grey  ramus.  In- 
asmuch as  the  function  of  medullation  is  unknown  the  point 
may  be  ignored  as  to  whether  or  not  the  fibres  are  medullat- 
ed,  excepting  to  note  the  fast  that  in  large  part  those  fibres 
which  arise  in  connection  with  the  spinal  cord  and  which 
should  property  be  considered  as  a  part  of  the  central  system, 
are  medullated,  while  those  arising  from  the  cells  in  the  sym- 
pathetic ganglia  and  hence  the  essential  sympathetic  fibres 
are  almost  entirely  non-medullated. 

Of  those  fibres  which  form  the  white  ramus  and  which 
arise  in  connection  with  the  central  system,  there  may  be 
recognized  three  distinct  types.  The  first  of  these,  arising  in 
cells  of  the  grey  matter  of  the  spinal  cord,  pass  out  by  way  of 
the  anterior  root  of  the  spinal  nerve,  through  the  common 
trunk,  into  the  anterior  primary  division,  and  from  thence 
;passes  with  others  to  form  the  white  ramus,  and  ends  in  con- 
nection with  one  or  other  of  the  ganglia  in  the  gangliated 
cord.  Fibres  of  this  type  may  either  end  in  the  ganglion 
first  reached  or  pass  up  or  down  to  end  in  an  adjacent  gang- 
lion, or  by  virtue  of  collaterals,  end  in  several  ganglia,  thus 
covering  territory  governed  by  from  one  to  four  ganglia. 

Fibres  of  the  second  type  also  arise  in  the  spinal  cord 
and  pass  out  in  the  same  manner  to  the  gangliated  cord,  but 
instead  of  ending  by  arborizations  in  connection  with  those 
ganglia,  pass  through  them  unchanged  and  enter  the  rami 
.efferentes  which  pass  to  the  prevertebral  plexuses.  Here  they 
may  end  around  cells  in  the  plexus  whence  the  impulses  are 
carried  onward  to  the  end  organ  by  a  new  neuron,  or  they 
may  pass  directly  through  the  plexus  to  reach  the  viscus  or 
intrinsic  cells  in  the  viscus.  This  type  and  the  first  named 
.are  efferent  in  function. 

The  third   type   of  white   fibres  has  its  origin  in  a  cell 


210 


PRINCIPLES    OF   OSTEOPATHY. 


Fig.  12. — Showing  distribution  of  fibres  of  white  rami. 

body  located  in  the  ganglion  of  the  posterior  nerve  root  from 
which  one  process  extends  centrally  to  arborize  around  other 
cells  in  the  cord,  while  another  leaving  by  way  of  the  posterior 
nerve  root  peripherally  passes  into  the  common  trunk  and 
thence  over  the  same  course  pursued  by  the  second  of  the 
above  types  to  end  without  further  interposed  neurons  in  con- 
nection with  the  viscera  to  which  it  is  distributed.  This  type 
constitutes  the  visceral  sensory  or  afferent  system  of  the  sym- 
pathetic. 

In  the  grey  ramus  are  fibres  which  pursue  various  courses. 
With  few  if  any  exceptions  these  grey  fibres  arise  from  the 
cell  bodies  composing  the  sympathetic  ganglia.  One  type 
thus  arising  from  the  ganglion  passes  outward  into  the  proxi- 


THE    SPINE. 


211 


Fig.  13. — Showing  distribution  of  fibres  of  grey  rami. 

mal  part  of  the  grey  ramus  but  leaves  it  before  the  junction 
with  the  spinal  nerve  proper  is  made,  to  join  the  recurrent 
branch  of  the  spinal  nerve  which  has  arisen  from  the  common 
trunk,  and  passes  with  the  fibres  of  that  branch  back  through 
the  intervertebral  foramen  giving  off  numerous  fibrils  which 
pierce  and  supply  the  ligaments,  muscles,  vertebrae,  and  various  of 
the  structures  in  the  circumferential  part  of  the  spinal  canal,  and  ul- 
timately reaching  the  coverings  of  the  cord. 

A  second  type  of  grey  fibre  passes  through  the  grey 
ramus  to  the  anterior  division  whence  it  passes  peripherally 
to  be  distributed  with  the  anterior  branch  of  the  spinal  nerve, 


212  PRINCIPLES   OF  OSTEOPATHY. 

furnishing  impulses  of  a  vaso-motor,  pilo-motor,    and  secre- 
tory character  to  the  structures  in  the  body  walls. 

A  third  type  passes  into  the  common  trunk  and  thence 
to  the  posterior  division  of  the  spinal  nerve  to  be  distributed  to 
structures  among  the  superficial  tissues  of  the  spinal  region. 

A  foiirth  type  passing  to  the  common  trunk  enters  the 
sheath  of  the  posterior  nerve  root  and  distributes  its  filaments  to 
the  intervertebral  structures  and  into  the  spinal  canal  as  far 
as  and  including  the  dura  mater  and  probably  reaching  the 
deeper  coverings.  No  similar  arrangement  has  been  noted 
definitely  with  reference  to  the  anterior  nerve  root. 

A  fifth  type  passes  by  a  connecting  cord  between  ad- 
jacent ganglia  and  thus  serves  to  connect  two  or  more  of  the 
ganglia  of  the  sympathetic  cord. 

The  last  type,  arising  from  a  cell  in  the  ganglion  passes 
by  way  of  the  ramtis  efferentes  to  terminate  possibly  in  a 
vagrant  ganglion  but  usually  directly  in  the  viscus  supplied 
from  the  plexus. 

With  regard  to  the  functions  of  these  various  fibres  both 
white  and  gray,  much  difference  of  opinion  exists,  but  enough 
is  known  to  indicate  the  following  general  facts.  Motor  fibres 
distributed  to  various  structures  are  known, such  as  vaso-motors 
both  constrictor  and  dilator,  the  former  largely  limited  in  their 
exit  from  the  cord  to  the  interval  between  the  first  thoracic  and 
second  lumbar;  -viscera-motors  and  mscero-inhibitors  passing  to 
supply  the  involuntary  muscle  tissue  of  the  viscera,  the  car- 
diac accelerators  from  the  upper  thoracic  region  being  a  special 
type  of  the  viscero- motor;  pupillo-constridors  and  dilators 
which,  distributed  to  the  muscle  tissue  of  the  iris,  produce 
effects  similar  to  the  other  of  the  motor  nerves.  In  addition 
to  the  motor  function  the  sympathetic  also  distributes  secretory 
fibres  to  the  sweat  glands  and  less  demonstrably  to  various 
other  glandular  structures.  Afferent  impulses  are  carried  by 
those  white  fibres  which  have  their  cell  bodies  in  the  root 
ganglion.  It  is  a  fair  assumption  that  afferent  fibres  pass  from 
the  viscera  to  end  in  the  sympathetic  ganglion,  but  experi- 


THE   SPINE. 


213 


mental  evidence  on  this  point  is  not  entirely  satisfactory. 

Regarding  the  possibilities  of  disorder  from  lesion 
of  the  spine  affecting  the  sympathetic,  much  may  be  said  in- 
dicating the  reasonableness  of  the  osteopathic  explanation  of 
disease.  It  was  suggested  that  the  ganglia  may  be  subject 
to  pressure  and  hence  disturbance  of  function  result,  but 
owing  to  the  fact  that  the  ganglion  is  protected  by  rather 
dense  fibrous  tissue  such  a  condition  is  less  likely  than  dis- 
turbance of  the  rami  communicantes  which  are  much  less 
thoroughly  protected.  Personally  however  we  are  inclined 
to  the  opinion  that  the  more  common  and  more  serious  of  the  dis- 
orders result  from  the  irritation  to  the  delicate  nerve  terminals  dis- 
tributed to  the  ligaments  and  other  vertebral  and  intervertebral  struc- 
tures as  they  are  given  off  from  the  recurrent  spinal  nerve  and  the 
filaments  which  pass  from  the  sheath  of  the  posterior  nerve  roots. 

Only  a  slight  lesion 
sufficient  simply  to 
put  upon  these  fila- 
ments a  slight  in- 
crease of  tension 
would  be  necessary 
to  produce  far- 
reaching  results. 
For  undoubtedly 
these  fila  m  en  ts 
passing  to  and 
through  the  liga- 
ments and  other 
connecting  tissues 
and  vascular  struc- 
tures and  through 
some  of  the  mus- 
cular slips  could  quite  easily  be  thus  irritated.  Note  further 
that  these  filaments  doubtless  govern  in  considerable  part  the 
nutrition  to  the  cells  in  the  spinal  cord,  producing  in  this  way  ef- 
fects similar  in  nature  to  those  suggested  in  discussing  the 


FIG.  14.— Showing  distribution  of  (1)  filaments  from 
posterior  nerve  root  and  (2)  from  recurrent  nerve,  to 
spinal  structures. 


214  PRINCIPLES    OF   OSTEOPATHY. 

effects  of  the  lesion  upon  the  intervertebral  vascular  system. 
Quain  makes  the  definite  statement  that  the  pia  mater  of  the 
cord  is  supplied  by  filaments  from  the  grey  raini.  Since  this  is  the 
sheath  that  governs  in  large  part  the  vascular  condition  of 
the  cord  lesion  to  these  fibres  will  certainly  be  productive  of 
disorder. 

THE  VASO -MOTOR  SYSTEM. 

In  order  to  understand  certain  further  effects  relative  to 
the  influence  of  lesions  on  the  sympathetic  and  Delated  systems 
a  brief  recapitulation  of  the  vaso- motor  mechanism  is  neces- 
sary. By  the  term  vaso -motor  is  meant  simply  a  nerve 
mechanism  which  governs  the  caliber  of  the  vascular  system 
by  increasing  or  decreasing  the  tone  of  the  muscle  tissue  in 
the  vessel  wall.  The  mechanism  is  probably  universal  in  the 
vascular  system  though  barely  demonstrable  in  the  lymphatic 
vessels  and  less  completely  shown  in  the  vein  than  in  the 
artery.  Presumably  the  capillary  system  is  destitute  of  any 
immediate  nerve  control.  The  arterial  side  of  the  circulation 
is  more  or  less  completely  under  such  control  and  in  large 
part  the  control  of  the  arterioles  comprehends  the  control  of 
the  vascular  system.  It  is  in  this  part  of  the  vascular  system 
that  there  is  found  the  greatest  relative  amount  of  muscle  tis- 
sue and  hence  the  greatest  abundance  of  nerve  distribution. 

Two  classes  of  vaso-motor  nerves  are  represented,  the 
constrictor  which  increases  the  tonic  condition,  and  the  dilator 
which  decreases  that  condition  corresponding  to  the  influence 
exercised  over  the  heart  muscle  by  the  vagus.  In  large  part 
the  same  nerve  trunk  contains  both  kinds  of  nerve  fibres.  In 
a  few  known  cases  they  are  distinct.  In  general  the  constric- 
tor nerves  are  limited  to  the  white  rami  which  are  given  off 
from  the  spinal  nerves  from  the  second  thoracic  to  the  second 
lumbar  inclusive,  while  the  dilators  are  contained  in  abun- 
dance in  several  of  the  cranial  and  spinal  nerves. 

The  vaso-motor  mechanism  is  essentially  a  reflex  arrange- 
ment in  which  the  efferent  pathway  only  contains  the  vaso-motor 


THE   SPINE. 


215 


nerves,  any  sensory  nerve  coming  into  relation  with  the  cell 
bodies  of  the  efferent  nerves  acting  as  the  afferent  pathway. 
Whether  there  are  special  afferent  nerves  associated  with  the 
vaso-motor  mechanism  is  not  definitely  known  except  in  the 

one  case   of   the 
depressor  nerve  of 
the  heart.    Sen- 
sory nerves  dis- 
tributed   to    the 
wall  of  the  artery 
itself  may  carry 
a  special   affer- 
ent impulse   for 
motor   response. 
The    condition  of 
the  blood    with 
reference  to   the 
quantity  or 
quality  may  be  a 
factor    in    the 
possible   au  t  o- 
matic    action    of 
certain  of   the 
vaso-motor  cen- 
ters.    The   third 
necessary   part 
in  the  reflex  arc 
is  the  center  and  there  are  numerous  such  associated  with  the 
constrictor   and   dilator  pathways.     The  general  vaso-motor 
center,  bilateral  in  arrangement,   is   known   to  exist  in   the 
medulla;  secondary  centers  are  found  in  the  cord,  indefinite  in 
number  and  influence  but  undoubtedly  acting  in  a  segmental 
capacity ;  some  authors  insist  on   further   secondary  centers 
located  in  the  ganglia  of  the  sympathetic  but  the  evidence  for 
this  proposition  is  inconclusive, although  it  would  seem  a  fair- 
ly, safe  assumption. 


FIG.   15. — Representation  of  way  in  which   a  viscus  se- 
cures increase  or  decrease  in   blood  supply. 


216  PRINCIPLES   OF   OSTEOPATHY. 

With  respect  to  the  action  of  the  two  forms  a  few  differ- 
ences have  been  noted;  the  constrictors  respond  more  quickly 
to  a  stimulus  though  the  effect  is  less  prolonged  than  is  the 
case  with  the  dilator;  the  constrictor  is  also  more  easily  ex- 
hausted and  degenerates  more  quickly  after  section;  the  con- 
strictor influence  is  a  continuous  one  while  the  dilator  is  an 
intermittent  one  and  serves  as  an  emergency  apparatus.  Each 
organ  of  the  body  is  supplied  with  a  local  mechanism,  the  so- 
called  vaso- motor  centers  being  represented  by  spinal  and 
other  areas,  as  follows: 

1.  All  parts  of  the  head  including  the  brain,  the  cervi- 
cal and  upper  thoracic  regions. 

2.  Lungs,  from  the  second  to  the  seventh  thoracic. 

3.  Heart,   the  pneumogastric    nerve   and   the    upper 
thoracic. 

4.  Intestines,  fifth  thoracic  to  the  second  lumbar. 

5.  Liver  and  spleen,  the  lower  thoracic. 

6.  Kidney,  lower  thoracic  and  upper  lumbar. 

7.  Bladder  and  generative  organs,  the  lumbar  and 
sacral  regions. 

8.  Limbs,  lower  cervical  to  upper  thoracic,   and   lower 
thoracic  to  upper  lumbar. 

The  several  regions  represent  those  parts  of  the  gray 
matter  of  the  spinal  cord  and  sympathetic  ganglia  which  seem 
to  act  as  definite  centers  for  controlling  the  local  supply,  and 
osteopathic  experience  bears  out  the  physiological  experi- 
mentation in  thus  assigning  these  various  regions. 

SPINAL  LESIONS  AFFECTING  VASO -MOTORS. 

It  is  a  striking  fact,  when  once  attention  is  called  to 
it,  that  in  the  vast  majority  of  disease  conditions  there  will 
be  either  a  condition  of  inflammation  or  evidence  of  a  previ- 
ous inflammatory  disorder.  Thus  an  ordinary  cold  in  the 
head,  or  a  bronchitis,  or  a  bronchial  pneumonia  is  but  an  in- 
flammation partially  dependent  upon  stagnant  blood ;  gastritis, 
peritonitis,  and  catarrahal  jaundice,  represent  similar  mucous 


THE   SPINE.  217 

inflammation ;  Bright's  disease  is  an  inflammation  following 
congestion  of  the  kidneys,  while  many  paralyses  and  valvular 
heart  troubles  represent  conditions  resulting  from  inflamma- 
tion. Osteopaths  are  firmly  of  the  opinion  that  in  an  indefi- 
nite though  undoubtedly  large  number  of  cases  a  part  if  not 
the  whole  of  the  cause  is  to  be  found  in  a  disorder  of  the  local 
vaso-motor  mechanism.  Stagnant  blood  is  always  a  predis- 
posing if  not  an  immediate  and  exciting  factor  in  the  produc- 
tion of  disease.  Further,  every  organ  and  tissue  requires  for 
its  normal  functioning  a  definite  amount  of  blood  and  a  suffi- 
ciently rapid  drainage.  Under  circumstances  of  perfect 
health  the  amount  of  blood  in  a  part  is  regulated  with  the 
most  exact  nicety.  When  because  of  increased  labor,  an 
organ — for  instance  the  stomach — requires  an  additional 
amount  of  blood  a  stimulus,  such  as  the  presence  of  food  ma- 
terials mechanically  acting  upon  the  gastric  mucous  lining, 
is  applied  to  the  nerve  terminals  distributed  there.  As  a  re- 
sult an  impulse  is  transmitted  along  the  visceral  afferent 
sympathetic  to  the  ganglion  or  segment  of  spinal  cord  which 
represents  the  local  vaso-motor  center.  This  center  is  in- 
fluenced in  such  a  way  as  to  send  out  efferent  impulses  over 
the  vaso- dilator  nerves  that  pass  by  way  of  the  sympathetic 
system  back  to  the  arterioles  associated  with  the  gastric 
mucosa.  Through  the  influence  of  these  nerves  the  muscle 
tissue  in  the  walls  of  the  arterioles  lessens  in  its  tone  and 
permits  the  general  blood  pressure  to  force  an  excess  of  blood 
into  the  yielding  vessels.  Or  this  other  possibility  presents, 
itself.  The  afferent  impulses  coming  into  relation  with  the 
cell  bodies  giving  off  constrictor  influences,  lessens  the  nor- 
mal chemical  and  vital  activity  in  the  cell  protoplasm  with  a 
consequent  lessening  of  the  intensity  or  rapidity  of  impulses 
that  continuously  pass  over  the  constrictor  nerves  distributed 
to  the  muscle.  The  effect  will  be  the  same  as  in  the  other 
case,  i.  e.,  a  dilatation  due  to  loss  of  tone,  and  general  blood 
'pressure.  (See  Fig.  15).  But  in  case  an  irritant  were  acting 
upon  some  part  of  this  mechanism  such  as  to  disturb  the  equi- 

15 


218  PRINCIPLES   OF   OSTEOPATHY. 

librium  of  the  impulses  associated  with  the  organ,  an  irregu- 
larity in  the  blood  supply  would  result  and  hence  a  disturb- 
ance of  function.  Such  an  irritation  could  easily  result 
from  a  spinal  lesion  of  almost  any  of  the  types  mentioned  in 
a  previous  section.  In  this  case  the  assumption  is  made  that 
the  lesion  affects  the  outgoing  nerve  and  this  causes  the  cir- 
culatory disturbance.  But  it  is  an  equally  plausible  one  that 
the  lesion  should  affect  fibres  of  an  afferent  nature  as  they 
pass  from  the  ganglion  through  the  devious  pathway  back  to 
the  spinal  cord  there  influencing  in  times  out  of  season  those 
cells  which  in  season  dispense  a  proper  quality  and  quantity  of 
impulses.  But  another  explanation  suggests  itself.  The  spinal 
*cord  has  its  vascular  system  and  its  vaso- motor  control  and 
•doubtless  each  segment  has  to  a  greater  or  less  extent  its  own  local 
•arrangement.  Those  fibres  which  control  the  caliber  of  the 
vessels  of  the  spinal  cord  pass  in  part  by  way  of  the  routes 
suggested  in  discussing  the  distribution  of  the  grey  rami.  It 
was  further  emphasized  that  these  filaments  that  pass  back 
into  the  canal  are,  of  all  parts  of  the  sympathetic  system,  the 
most  subject  to  lesion.  Hence  when  a  lesion  occurs  these 
fibres  above  all  others  will  be  the  ones  to  suffer,  which  means 
conditions  in  the  spinal  cord  analgous  to  those  referred  to  in 
connection  with  the  stomach..  That  is,  a  condition  either  of 
ischaemia  or  hyperaemia  of  the  cord  may  result,  in  either  case 
producing  a  disturbance  in  the  outgoing  impulses  from  all 
parts  of  the  segment.  Note  that  theoretically  there  are  two 
possible  explanations  of  both  the  hyperaemic  and  ischaemic 
conditions  resulting  from  vaso- motor  disturbance.  Hyper- 
aemia will  result  from  either  a  stimulation  of  the  vaso -dilators 
or  an  inhibition  of  the  vaso -constrictors,  while  ischsemia  will 
result  from  either  a  stimulation  of  the  constrictor  or,  provided 
we  accept  the  doubtful  assumption  that  the  dilator  is  continu- 
ously active,  the  inhibition  of  the  dilators.  Where  both  fibres 
to  the  same  part  are  acted  upon  equally  the  immediate  resuU 
may  not  be  apparent  for  the  one  will  tend  to  counteract  the 
other.  But  in  a  comparatively  short  time  when  both  ele- 


THE   SPINE. 


219 


ments  become  exhausted,  dilatation  will  result,  and  the  effect 
in  the  long  run  will  always  be  an  inhibition  of  the  tone  of  the  ves- 
sel. Hence  we  should  expect  to  find  in  most  diseases  depen- 
dent upon  irritation  to  the  vaso-motor  mechanism,  a  congest- 
ed condition,  and  such  indeed  are  the  observed  facts. 

In  case  of  a  lesion  thus  present  and  producing  manifest 
disorder,  it  must  not  be  assumed  that  the  effect  is  a  simple 
one.  For,  because  of  the  strain  in  the  production  of  the 
lesion  and  because  of  the  interference  with  the  mechanism 
controlling  the  nutritive  conditions  of  the  entire  local  spinal 
structures,  there  will  be  pressure  exerted  in  all  directions 
through  the  congestion  and  infiltration  of  the  structures,  thus 
making  possible  countless  varieties  of  local  and  remote  effects. 

But  it  is  not 
n  e  c  e  s  sary  to 
assume  that  the 
sympathe  tic 
system  or  the 
vaso-motor  me- 
chansim  must 
itself  be  sub- 
jected to  pres- 
sure f  r  o  m  t  h  e 
lesion.  For,  in 
connection  with 
the  segment  of 
the  co  r  d  are 
myriads  of 
spinal  affe  rent 
p  a  thways  from 
the  deep  and 
superficial, near 
a  nd  r  emo  t e 

Fig.  16.— Diagrammatic    explanation    of  disordered  viscus 

from  contractured  spinal  muscles.  S  tTUCtUreS, 

which  are  continually  pouring  in  their  streams  of  impulses  from 
the  periphery.     An  irritating  force  acting  upon  these  afferent 


220 


PRINCIPLES   OF   OSTEOPATHY. 


fibres  will  cause  an  excess,  in  the  metabolism  of  the  segment 
involved.  From  this  conception  we  may  understand  the  ex- 
planation of  congestive  and  catarrhal  conditions  of  the  vari- 
ous viscera  dependent  on  muscle  contracture.  Owing  to 
the  wide  distribution  of  afferent  spinal  nerves  in  and  among 
the  fibres  of  the  muscle  a  contractured  condition  of  that  tissue 
will  produce  an  increase  in  the  shower  of  impulses  transmit- 
ted to  the  spinal  segment.  Hence  from  exposure  or  other 
cause,  if  the  upper  thoracic  spinal  and  chest  muscles  con- 
tract, a  congested  condition  of  the  lung  structures  will  result 
and  the  way  opened  for  bronchitis  or  pneumonia;  if  the  lower 
thoracic  or  lumbar  structures  be  tightened,  congested  or 
catarrhal  conditions  of  the  intestinal  mucosa  occurs  and  a 
diarrhoea  results;  or  a  thickening  of  the  suboccipital  tissues 
will  produce  congestion  of  the  nasal  and  orbital  regions  and 
a  cold  in  the  head  with  conjunctivitis  follows.  This  will  be 
dependent  on  a  more  or  less  general  physiological  law  that 

has  been  referred  to,  i.  e., 
the  activity  of  a  given 
collection  of  nerve  cells 
depends  upon  the  total 
number  of  impulses  that 
pass  to  it  from  all  sources. 
This  does  not  necessarily 
mean  that  the  greater  the 
number  of  such  impulses 
passing  to  the  center  the 
greater  will  be  the  activ- 
ity of  the'part  in  sending 
out  impulses;  for  it  is 
known  that  one  of  the 
functions  of  the  higher 
parts  of  the  nervous  sys- 
tem is  that  of  inhibiting 
actions  that  would  other- 
wise take  place.  This  function  of  inhibition  is  pre-eminently 


Fig.  17. — Showing  the  numerous  areas  from 
which  segment  of  cord  may  be  influenced. 


THE   SPINE. 


221 


a  power  of  the  cortex  but  some  evidence  indicates  that  the 
spinal  cord  may  exercise  it  under  certain  circumstances.  The 
law  may  be  further  modified  by  the  unknown  factor  of  a  vital 
directing  force ;  but  in  general  the  action  of  the  center  will 
vary  with  the  number  and  intensity  of  stimuli  reaching  it 
from  the  periphery  or  other  parts  external  to  it. 

In  connection  with  the  above  it  is  advisable  to  further 
emphasize  the  fact  of  radiation  of  impulses  which  is  a. 
phenomenon  of  all  nerve  tissue.  Normally  the  effect  of  an  in- 
coming impulse  will  be  associated  mostly  with  the  segment 
that  receives  it.  For  instance,  the  phenomena  of  Pfluger's 
laws  of  unilateral  and  symmetrical  response  show  that  a  slight 
stimulus  will  affect  only  the  limb  to  which  the  stimulus  was 

applied.  Increase  the  inten- 
sity or  duration  and  the 
corresponding  limb  will  re- 
spond. Still  further  intensify 
the  stimulus  and  there  is 
produced  a  radiation  up  and 
down  in  the  adjacent  seg- 
ments, showing  an  overflow 
of  impulses  from  the  seg- 
ment which  receives,  into 
those  nearest  at  hand.  The 
phenomenon  is  also  noticed 
in  connection  with  the  im- 
FIG.  is.— illustrating  Pfluger's  laws  of  mersion  of  one  hand  in  hot 

the  reflex.   Stimulus  applied  at  a  will  pro-  water;    in     this    Case    bo  t  h 

duce  response  in  serial  order  in  fibre  1,  2,  3, 

and  4,  depending  on  a  graduated    applica-  llBflbs  respond  by  VaSO-motor 

tion.  changes.  Considering  these 

various  facts  it  is  not  at  all  difficult  to  believe  that  a  stimulus 
in  the  nature  of  a  continued  contracture  of  a  spinal  muscle 
may  result  in  sufficient  local  change  of  spinal  cord  metabolism 
to  affect  the  cell  bodies  whose  axis  cylinder  processes  pass 
through  the  sympathetic  system  to  be  distributed  to  various 
end  organs  in  the  viscera.  Or  on  the  other  hand  it  is  no  more 


222 


PRINCIPLES   OF   OSTEOPATHY. 


difficult  to  conceive  of  a  sufficient  number  of  visceral  sensa- 
tions— pain,  for  instance — passing  to  the  cord  segment,  to 
there  cause  an  overflow  into  the  cell  bodies  whose  processes 
pass  to  the  spinal  muscles.  In  this  latter  case  a  secondary 
muscle contr,acture  would  be  the  result. 

Another  suggested  explanation  of  the  effect  of  contrac- 
tured  spinal  muscles  upon^the  various  viscera,  has  reference 
to  the  anatomical  relations  between  the  blood  supply  to  the 
cord  and  that  to  the  muscles.  Taking  a  typical  region,  the 
thoracic,  it  will  be  noticed  that  the  same  branch  of  the  inter- 
costal artery  supplies  both  the  spinal  cord  and  the  spinal 

muscles  and  other 
superficial  tissues. 
The  contracture  of 
those  spinal  tissues 
acts  in  a  mechanic- 
al way  to  obstruct 
the  blood  flow  to 
and  from  the  super- 
ficial spinal  region 
with  a  consequent 

FIG.  19. — Illustrating  Hart's  theory.  forcing    of    an     6X- 

cess  of  blood  into  those  branches  most  closely  related,  i.  e., 
the  branches  to  the  spinal  cord.  As  a  result  there  will  be  a 
disturbed  cord  metabolism  from  the  hypersemic  condition 
produced;  and  the  same  numerous  immediate  and  remote  ef- 
fects referred  to  above  will  be  produced.  This  explanation, 
usually  referred  to  as  Hart's  theory,  is  not  entirely  satis- 
factory, but  nevertheless  is  of  value  as  helping  to  explain  all 
disorders  due  to  a  collateral  hyperaemia.  While  it  is  possible 
that  those  branches  nearest  to  the  ones  obstructed  will  be  first 
involved  in  an  overfilled  condition  it  cannot  long  persist  ex- 
cept an  impairment  of  the  local  vaso-motor  mechanism  be  produced. 
For  the  blood  stream  throughout  the  entire  system  being 
an  open  one,  the  entire  system  will  expand  to  accommodate 
the  blood  shut  out  from  the  superficial  spinal  area,  owing  to 


THE   SPINE.  223 

the  pressure  of  fluids  being  propagated  equally  in  all  direc- 
tions. If  there  is  a  less  resistance  associated  with  the  branch- 
es to  the  cord,  then  there  will  be  a  tendency  for  dilatation  in 
these.  And  this  condition  is  likely  soon  to  result  owing  to 
the  usually  complex  nature  of  the  spinal  lesion.  But  this  will 
manifestly  involve  the  integrity  of  the  local  nerve  apparatus, 
and  hence  it  is  necessary  to  consider  that  involvement  as  an 
essential  in  the  production  of  a  disorder  of  any  permanency. 
The  fact  that  a  blockage  of  any  part  of  the  vascular  system 
thereby  producing  a  hypersemic  or  ischaemic  condition  in  the 
part,  will  secondarily  produce  the  opposite  condition  in  some 
other  part,  is  worthy  of  attention  whether  it  be  in  relation  ta 
the  spinal  cord  or  other  structure.  Owing  to  the  approximate 
constancy  in  amount  of  the  total  fluids  of  the  body  a  hyper- 
semia  in  one  part  means  an  ischaemia  of  another,  whether  due 
to  direct  pressure  on  the  vessel  or  to  vaso- motor  disorder. 

OTHER  EFFECTS. 

What  has  been  said  with  reference  to  the  effect  of  the 
spinal  lesion  upon  the  vaso-motor  mechanism  will  be  true  in 
large  part  with  reference  to  the  other  functions  of  the  sym- 
pathetic fibres.  In  the  upper  thoracic  region  the  lesion  may 
affect  the  pupillo-constridor  and  dilator  fibres  which  pass  to  the 
muscle  tissue  of  the  iris  with  a  resulting  condition  of  dilated 
or  narrowed  pupil.  In  the  same  region  arise  the  fibres  which 
carry  accelerator  impulses  to  the  heart  muscle.  Hence  the 
lesion  may  produce  over -activity  or  lessened  activity  of  the 
cardiac  muscle.  In  the  middle  thoracic  the  viscero-motors  to 
the  upper  intestine  may  be  excited  and  a  condition  of  muscu- 
lar cramp  or  increased  peristalsis  may  result;  or  on  the  other 
hand  the  viscera-inhibitors  may  be  disturbed  and  a  disorgani- 
zation of  intestinal  motion  follow.  Throughout  all  parts  of 
the  spine  lesions  may  interfere  with  the  pilo-motor  fibres  that 
are  given  off  and  hence  disturbance  of  the  functioning  of  the 
hair  and  of  the  sebaceous  glands  will  occur.  The  secretory 
fibres  that  pass  to  the  sweat  glands  in  all  parts  of  the  body 


224  PRINCIPLES   OF   OSTEOPATHY. 

may  be  irritated  by  the  lesion  and  changed  secretion  with 
various  associated  effects  be  the  consequence,  while  similar 
fibres  which  pass  to  the  visceral  glandular  organs  may  be 
equally  disordered  with  a  resulting  disturbance  of  external  or 
internal  secretions  which  may  have  the  most  profound  effects 
upon  both  local  and  general  body  metabolism. 

It  has  been  pointed  out  that  with  the  bony  or  other  deeper 
lesion  there  will  usually  be  a  muscle  contracture  which  may 
be  primary  or  secondary.  By  reference  to  the  sympathetic 
system  the  student  is  prepared  to  understand  how  a  second- 
ary muscle  contracture  may  be  produced  from  a  diseased 
viscus.  For  a  specific  case  we  may  take  the  condition  of 
gastritis.  In  such  a  condition  there  will  be  irritation  to  the 
mucous  lining  of  the  stomach  which  affects  the  terminals  of 
the  sensory  nerves  distributed  therein.  As  a  result  an  affer- 
ent impulse  passes  by  way  of  the  sympathetic  afferent  nerves 
arbund  to  the  posterior  nerve  root  and  thence  into  the  spinal 
cord.  Here  it  will  influence  various  of  the  cell  bodies  with 
which  it  comes  into  relation.  Among  these  are  the  cells  in 
the  anterior  horn  of  the  grey  matter  whose  axis  cylinder' pro- 
cesses pass  out  by  the  anterior  nerve  root  and  over  the 
posterior  primary  division  of  the  spinal  nerve  to  the  muscles 
of  the  thoracic  region  of  the  spine.  These  fibres  carry  first, 
motor  impulses  to  the  muscle  fibres,  and  hence  the  in- 
crease in  the  impulse  may  be  sufficient  to  cause  a  simple 
muscle  contraction  which  if  long  continued  will  develop  into 
a  typical  contracture.  But  secondly,  the  cell  body  irritated 
may  give  rise  to  impulses  which  are  transmitted  by  way  of 
the  sympathetic  fibres  to  the  posterior  primary  division  and 
end  in  connection  with  the  muscle  tissue  in  the  walls  of  the 
muscle  vessels.  These  influences  may  be  either  constrictor  or 
dilator  in  character  and  in  either  case  a  disturbance  of  the 
muscle  nutrition  will  result  which  will  lead  to  contracture. 
Ultimately  whether  constrictor  or  dilator  is  affected  the  vas- 
cular condition  will  be  one  of  stagnation. 

But  it  would  seem   unnecessary  to  assume  that  the  im- 


THE   SPINE. 


225 


pulse  along  the  sympathetic  afferent  fibre  should  pass  to  the 

spinal  cord  at 
all.  As  before 
indicated  there 
is  some  evi- 
dence and 
much  reason  to 
show  that  some 
of  the  afferent 
fibres  from  the 
viscus  end  in 
connection  with 
the  cell  bodies 
of  the  ganglia 
of  the  sympa- 
thetic. It  is 
known  that 
here  are  cells 
whose  pro- 
cesses  pass  to 
the  p  o  sterior 
primary  divi- 
sion of  the 
spinal  nerve.  It 
muscle  con.  is  entirely  rea- 
son  able  to  as- 


o 


Fig.  20.  —  Diagrammatic  explanation   of  spinal 

tracture  secondary  to  visceral  disorder. 


sume  that  the  afferent  impulse  ending  in  the  ganglion  initi- 
ates changes  in  the  cell  bodies  by  a  process  of  radiation 
of  impulses  which'is  universal  in  all  grey  matter,  sufficient  to 
affect  those  cells  which  convey  vaso- motor  or  other  impulses 
to  the  muscle  tissue  of  the  spinal  area,  resulting  in  a  contrac- 
ture affect.  Altogether  the  facts  of  anatomical  nerve  dis- 
tribution and  the  laws  of  nerve  action  make  it  quite  reason- 
able that  a  contracture  may  be  produced.  The  fact  of  the 
secondary  contracture  will  hardly  be  denied  though  the  ex- 
planations may  be  at  fault. 


226  PRINCIPLES   OF   OSTEOPATHY. 


CHAPTER  XL 


CERVICAL  LESIONS— DIAGNOSIS  AND  TREATMENT. 
SUPERFICIAL  STRUCTURES. 

The  points  emphasized  in  a  previous  chapter  regarding  the 
necessity  for  observing  the  part  under  different  functional 
conditions  hold  especially  in  case  of  the  neck.  The  man- 
ner in  which  the  head  is  held  while  the  patient  is  in  an  erect 
position,  is  in  numerous  cases  suggestive  of  cervical  disorder. 
The  lateral  inclination  of  the  head  suggests  a  lesion  of  some 
form,  usually  contracture,  on  the  side  toward  which  the  head 
is  inclined.  Torticollis  is  a  typical  example  of  the  extreme 
type.  The  carefulness  with  which  the  head  is  carried  suggests 
an  inflammatory  disorder  of  the  deep  tissues  such  as  caries, 
a  severe  headache,  or  other  condition  in  which  the  jarring  of 
the  body  is  associated  with  increased  pain.  The  general  con- 
tour of  the  lines  of  the  neck  with  reference  to  the  presence  of 
regions  of  fullness  or  depression  should  be  noted.  In  many 
cases  a  distinct  difference  will  be  detected  in  the  prominence 
of  two  corresponding  parts  of  the  neck, which  is  suggestive  of 
disorder.  Note  however  that  it  is  not  proof  of  such  disorder. 
It  often  occurs  that  the  side  most  used  will  show  greater  mus- 
cular and  general  tissue  development  than  does  the  other. 
Hence  the  necessity  for  inquiring  as  to  the  relative  use  of  the 
two  sides,  the  occupation,  or  the  exercise  habits  of  the  in- 
dividual. It  is  well  to  speak  in  this  connection  of  the  neces- 
sity for  careful  comparison  of  sides  where  symmetrical  struc- 
tures present  themselves,  for  it  is  common  experience  that  a 
part  may  vary  from  the  type  pictured  as  normal  in  the  mind 
of  the  physician  and  still  be  normal  so  far  as  the  one  under 
examination  is  concerned. 

With  the  patient  in  the  horizontal  position  additional 


CERVICAL  LESIONS — DIAGNOSIS  AND  TREATMENT.         227 

facts  may  be  brought  out  owing  to  the  greater  relaxation 
that  is  secured  simply  by  the  assumption  of  this  position. 
With  the  ordinary  patient  undergoing  his  first  examination 
there  will  be  considerable  anxiety  or  nervousness  which  of 
itself,  through  influencing  various  nerve  connections,  would 
tend  to  obscure  the  usual  condition.  In  this  position  there 
will  be  a  less  restraint  on  the  part  of  the  patient,  and  by  en  • 
gaging  him  in  conversation  or  otherwise  getting  his  mind 
employed,  the  muscle  tissues  will  still  further  undergo  a 
spontaneous  relaxation. 

With  the  patient  in  these  different  positions  the  f ollow- 
ing  should  be  carefully  examined ;  muscle  groups  including 
the  lateral,  posterior,  and  anterior;  ligamentous  structures 
which  comprehend  the  deep  vertebral  connecting  tissues  and 
the  ligamentum  nuchae;  the  cervical  vertebrae,  inferior  max- 
illary, and  hyoid  bones ;  the  laryngeal  and  tracheal  cartilages ; 
the  tonsils,  thyroid  and  lymphatic  glands;  and  those  vascular 
and  nervous  structures  that  can  be  more  or  less  directly 
reached. 

Notice  the  situation  and  the  condition  of  the  sterno- 
mastoid  muscle.  Owing  to  its  prominence  it  serves  as  a 
definite  landmark  for  locating  other  structures  and  assists  in 
overcoming  certain  lesion  conditions.  The  muscle  can  be 
made  prominent  by  rotating  the  head  to  the  side  opposite  the 
muscle  examined  and  can  be  put  upon  the  stretch  by  bending 
the  head  to  the  opposite  side  and  rotating  it  toward  the  same 
side.  This  latter  movement  will  assist  in  elevating  the  an- 
terior end  of  the  clavicle,  sternum,  and  upper  ribs.  Occasion- 
ally the  muscle  will  be  found  contractured  or  otherwise  in  a 
disordered  condition.  By  attention  to  the  region  of  its  nerve 
supply  together  with  some  direct  work  upon  the  muscle  itself 
the  condition  .can  usually  be  overcome.  Of  the  structures 
which  lie  in  close  relation  to  the  muscle,  several  are  impor- 
tant :  the  carotid  artery,  the  internal  jugular  vein,  and  the 
vagus  nerve  in  their  common  sheath  of  connective  tissue  pass 
through  the  cervical  region  behind  the  anterior  margin  of  the 


228  PRINCIPLES   OF   OSTEOPATHY. 

muscle;  the  cervical  portion  of  the  sympathetic  cord  lies 
underneath  the  common  sheath;  cervical  nerves  including  the 
phrenic  and  the  brachial  plexus,  will  be  found  behind  the 
lower  half  of  the  muscle  in  close  association  with  the  scaleni; 
the  superficial  and  deep  cervical  lymphatics  also  lie  in  close 
relation  to  this  muscle  and  in  many  cases  of  inflammatory 
disorders  of  the  upper  respiratory  and  digestive  tracts,  the 
glands  will  be  found  enlarged  and  tender,  in  which  case  they 
should  be  avoided  as  much  as  is  possible  in  examining  and 
manipulating  the  associated  structures.  These  various  organs 
may  be  more  or  less  irritated  by  disordered  conditions  of  the 
muscle. 

The  scaleni  muscles  are  of  considerably  greater  impor- 
tance to  the  osteopath  than  is  the  sterno-mastoid,  in  so  far 
as  their  own  abnormal  conditions  and  the  production  of  ab- 
normal conditions  of  other  parts  are  concerned.  Notice  the 
attachments  and  situation  of  these  muscles.  Ignoring  the. 
posticus,  often  absent  and  seldom  important,  these  muscles 
are  concerned  with  changing  the  position  of  the  cervical  ver« 
tebrae  and  the  first  rib.  The  normal  condition  of  the  scaleni 
muscles  seems  to  be  one  of  greater  density  and  tension  than 
that  of  the  average  muscle  at  rest,  and  the  student  should  be- 
come familiar  with  the  normal  sensation  in  their  palpation. 
Note  the  further  fact  that  they  lie  in  close  relation  to  the  ir- 
regular and  roughened  transverse  processes  so  that  any  pres- 
sure or  other  direct  manipulation  should  be  done  with  caution, 
or  an  irritation  and  hence  additional  contracture  will  result. 
These  muscles  may  be  easily  detected  by  palpation  posterior 
to  the  lower  half  of  the  sterno-mastoid  muscle  and  following 
along  and  in  front  of  the  row  of  transverse  processes.  In  a 
contractured  condition  one  or  both  of  tivo  effects  will  occur,  i.e., 
a  distortion  of  the  cervical  vertebrae  or  a  subluxation  upward 
of  the  first  rib.  In  most  cases  it  will  be  the  latter  and  a 
tightened  and  tender  basal  portion  of  the  neck  will  be  com- 
plained of  by  the  patient.  The  contracture  of  the  scaleni  will 
be  dependent  on  irritation  to  the  cervical  branches  which  supply 


CERVICAL  LESIONS — DIAGNOSIS  AND  TREATMENT.  229 

them,  and  hence  adjusting  the  deeper  lesions  will  be  the  fun- 
damental treatment.  Aid  may  be  given  by  direct  treatment 
to  the  muscles  in  the  various  ways  suggested  for  overcoming 
contractured  muscles.  A  common  method  is  a  serial  one  of 
stretching,  approximation  of  orgin  and  insertion,  and  direct 
pressure.  One  hand  flexes  the  head  to  the  opposite  side 
enough  to  slightly  tense  the  muscles,  then  as  the  head  is 
rotated  back,  pressure  is  made  by  the  other  hand  directly 
upon  the  muscle;  but  the  pressure  must  be  carefully  applied  or 
the  treatment  will  avail  nothing.  These  muscles  may  be  used 
for  purposes  of  adjusting  the  ribs  and  vertebras  and  will  be 
spoken  of  in  that  connection  under  the  appropriate  subject. 
Structures  in  close  relation  to  the  scaleni  muscles  and  subject  to 
lesion  therefrom  are  branches  of  the  cervical  plexus,  phrenic 
nerve,  brachial  plexus,  and  arterial  and  venous  channels,  to- 
gether with  a  few  of  those  mentioned  in  connection  with  the 
sterno-mastoid.  The  brachial  plexus  is  of  special  import  be- 
cause of  its  close  relation.  Fibres  composing  the  plexus  arise 
from  between  the  anticus  and  medius  and  form  upon  the 
lower  part  of  those  muscles,  passing  therefrom  over  the  first 
rib  to  reach  the  axilla. 

The  posterior  muscles  are  of  much  value  in  diagnosis 
and  are  interesting  in  their  assiociation  with  many  diseases 
of  the  cervical  and  cephalic  structures.  Attention  is  called 
to  the  fact  that  in  numerous  instances  there  will  be  a  quite 
appreciable  dijjerence  in  temperature  between  the  posterior  and 
other  groups  of  cervical  muscles,  the  condition  of  the  former 
usually  being  one  of  a  lower  temperature  than  that  of  the  lat- 
ter. Especially  is  the  suboccipital  region  worthy  of  notice. 
Perhaps  no  other  region  of  the  body  is  so  often  found  in  a 
state  of  contracture  or  so  often  made  use  of  in  manipulation. 
The  depression  in  the  mid-line  next  the  occiput  caused  by  a 
partial  division  of  the  ligamentum  nuchas  and  less  abrupt 
ones  on  either  side  of  the  upper  attachment  of  that  structure 
are  to  be  noticed.  Pressure  in  these  regions  \vill  often  cause  a 
sensation  of  pain  or  fullness  in  different  parts  of  the  head. 


230 


PRINCIPLES   OF   OSTEOPATHY. 


Headaches,  general  vaso-motor  disturbances,  feverishness, 
and  the  like  are  often  caused  and  cured  in  this  region.  In 
nearly  all  cases  of  headache  some  relief  may  be  given  by  a 
strong  but  careful  relaxing  pressure  applied  by  bending  the 
head  back  against  the  fingers  pressed  deeply  into  the  tissues 
at  this  point.  Owing  to  the  close  relation  of  the  centers  in 
the  medulla  to  this  part  of  the  spinal  cord,  various  effects, near 
and  remote,  may  be  gotten  by  a  relaxive  and  adjustive  ap- 
plication. The  ligamentum  nucha  is  a  structure  associated 
with  this  region  which  is  of  interest  to  the  osteopath.  Its  at- 
tachments are  suggestive ;  above  to  the  occiput,  below  to  every 
spinous  process  from  the  seventh  cervical  to  the  sacrum.  For  it  is 
practically  continuous  with  the  supra - 
spinous  ligaments  in  the  other  parts  of 
the  spine.  In  many  cases  the  ligament 
itself  seems  to  be  in  a  contracted  state, 
and  the  patient  will  complain  of  a  draw- 
ing sensation  in  that  area.  Often  the 
simple  process  of  flexing  the  head  for- 
ward on  the  chest  will  produce  a  tern- 
pory  if  riot  permanent  relief.  It  is  of 
further  value  as  a  factor  in  diagnosis. 
The  tensing  of  the  ligament  as  above 
suggested  will  put  on  tension  all  of  the 
ligamentous  slips  between  adjacent 
spinous  processes  throughout  the  spine. 
Owing  to  the  usual  oblique  direction  of 
the  spinous  process  a  considerable  lever- 
age will  be  secured.  If  lesion  exists  'in 

Fio.    21.— Showing  lever-  . 

age  secured  on  spinous  pro-   any  Par>t  and    if  pain    IS     present    it    Will 

cesses  by  forward  flexion  of  likely    be    felt     when    the    flexion    is 
produced.     In  some  cases  where   other 

methods  fail  to  show  tenderness  this  is  quite  effective.  As  a 
means  of  securing  adjustment  oi  parts  the  ligament  is  valuable. 
By  the  pull  upward  parts  maybe  separated  and  moved  some- 
what laterally,  and  if  pressure  with  the  free  hand  be  employ- 


CERVICAL   LESIONS — DIAGNOSIS   AND   TREATMENT.  231 

ed  upon  the  spinous  process  movement  of  any   vertebra  may 
be  effected. 

The  hyoid.  bone  is  a  structure  that  should  be   carefully 
noticed.     Having  no  articulation   with   other  osseous   tissues 
and  being  suspended  within  ligamentous  and  muscular  struc- 
tures, its  relative  position  is  indicative  of  the  condition  of  the 
latter.     Usually  there  will  be  little  difficulty  in  locating  it  but 
in  occasional  cases  where  there  is  an  excess  of  other  cervical 
tissue  or  a  denseness  of  surrounding  structures  some  difficulty 
may   be   encountered   by  the   inexperienced  in  detecting  its 
position.     Note  that  it  is  the  first  dense  structure  lying   above 
the  prominence  of  the  thyroid  cartilage,  the  latter  always  be- 
ing sufficiently  prominent  to  be  easily  detected.     By   placing 
the  hand   over  the  tissues  on  one  side  and  pressing  to  the 
other,  the  greater  cornua  of  the  opposite  side  will  be  detected 
through  the  tissues.     Then  by  maintaining  contact  with   this 
and  exerting   pressure  back  again,    the   other   will   be  felt. 
Note  the  readiness  with  which  it  yields   to  pressure   between 
the  fingers.     Ii(it  resists,  ossification  is  well  developed;    other- 
wise,    as   in  all  younger  individuals,  it  is  quite  yielding  and 
indicates  its  cartilaginous  composition.  The  cornuae  can  usu- 
ally be  traced  back  to  their  continuation  with  the  ligamentous 
structures  which  suspend  the  bone.     Note  these  deep  tissues  . 
to  determine  their  contracture  and  tenderness.     Compare  the 
two  cornuae  in  regard  to  their  respective  levels.     When  one  side 
is  higher  than  the  other  it  usually  means  a  contracture  on  the 
same  side,  of  the  supra- hyoid  muscles;  less  often  a  contrac- 
ture  of   the  infra- hyoid   muscles  on  the  opposite  side.     The 
feeling  of   the  tissues   themselves  together  with  the  sensory 
condition  manifested  will  render   the   difficulty    of  diagnosis 
less  serious. 

The  discussion  of  the  hyoid  leads  logically  to  the  con- 
sideration of  the  throat  structures.  These  are,  taken  as 
a  whole  and  separately,  of  the  greatest  importance.  In  every 
case  of  throat  or  nasal  difficulty  as  well  as  disorders  of  other 
parts  in  that  region,  these  muscles  will  be  found  in  a  condi- 


232  PRINCIPLES   OF   OSTEOPATHY. 

tion  of  tenderness  and  contracture.  Pain  can  be  easily  pro- 
duced by  deep  pressure  upward  and  inward,  in  a  normal 
condition,  but  will  be  quite  marked  where  abnormality 
exists.  In  many  cases  of  catarrh  this  region  may  be  the 
only  one  presenting  sensory  disturbance.  In  their  close  re- 
lation to  the  cervical  vessels  and  nerves,  contracture  of  these 
tissues  can  very  easily  affect  portions  of  the  body  above  and 
below.  The  direct  relaxation  of  the  parts  may  be  most  readily 
effected  by  placing  the  patient  in  the  supine  position,  and 
standing  at  the  side,  reach  over  and  with  the  flat  of  the  hand 
and  fingers  exert  deep  but  gradual  and  careful  pressure,  at 
the  same  time  rolling  the  head  to  the  opposite  side  or  lifting 
it  up  and  flexing  it  directly  over  and  upon  the  manipulating 
hand.  This  latter  movement  markedly  increases  the  approxi- 
mation of  origin  and  insertion  and  allows  deeper  pressure 
with  less  irritation.  In  many  cases  this  treatment  will  be 
little  more  than  a  temporary  expedient,  and  hence  it  will  be 
necessary  to  look  for  the  deeper  lesions  which  can  usually  be 
found  associated  with  disturbance  of  the  upper  cervical  ver- 
tebrae, the  removal  of  this  last  named  being  the  logical  meth- 
od for  permanent  cure. 

The  tonsils  will  be  noticed  if  they  are  in  an  inflamed  or 
enlarged  condition.  Normally  they  are  not  subject  to  palpa- 
tion externally,  but  on  considerable  enlargement  will  be  felt, 
together  with  the  infiltrated  tissues — which  is  a  usual  ac- 
accompaniment — by  pressing  deeply  upward  underneath  the 
angle  of  the  inferior  maxillary  bone  toward  thefaucial  region. 
Internally,  whether  in  a  normal  or  other  condition,  they  will 
be  seen  on  either  side  of  the  isthmus  of  the  fauces.  The  ton- 
sil is  a  lymphoid  structure  and  should  not  be  directly  treated 
except  with  extreme  care. 

The  cartilages  associated  with  the  respiratory  tract 
should  be  examined.  The  prominence  known  as  "Adam's 
Apple"  (pomum  Adami)  usually  more  marked  in  the  male,  is 
the  most  noticeable  part  of  the  thyroid  cartilage  and  is  valua- 
ble as  a  landmark  for  locating  the  hyoid  bone  above  and  the 


CERVICAL  LESIONS — DIAGNOSIS   AND   TREAMENT.  233 

thyroid  gland  below.  Note  should  be  taken  of  the  yielding 
or  resisting  nature  of  the  cartilage,  the  latter  suggesting  an 
ossification  which  is  comparatively  common  among  elderly 
individuals  and  more  common  than  a  similar  condition  of  the 
other  cartilages.  Movement  of  the  thyroid  against  the  cri- 
coid  immediately  below  it,  produced  by  lateral  to -and -fro 
pressure,  will  usually  show  a  form  of  crepitus.  No  particular 
significance  is  to  be  attached  to  the  condition  but  the  patient 
will  often  assume  that  something  is  wrong  on  discovering  the 
peculiarity.  In  palpation  over  these  structures  a  tendency  to 
produce  coughing  may  be  noticed.  This  is  suggestive  of  a 
hyper-irritable  state  of  the  vagus  or  of  the  laryngeal  branches 
which  supply  the  structures. 

Underneath  the  laryngeal  cartilages  in  the  median  line 
and  on  either  side  will  be  felt  the  thyroid  gland  more  develop- 
ed in  the  female  adult.  The  isthmus  which  connects  the  two 
lateral  lobes  is  a  half  inch  in  width  and  crosses  the  median 
line  in  front  of  the  second  or  third  tracheal  ring  of  cartilage. 
The  lateral  lobes  extend  above  and  below  this  level  to  a  vari- 
able distance.  In  many  individuals  the  gland  will  be  rather 
indistinct  on  inspection  or  palpation  but  in  others  it  will  be 
quite  prominent.  An  enlarged  condition  is  spoken  of  as 
goitre,  and  is  a  disorder  quite  commonly  met  with.  Owing  to 
the  pliable  nature  of  its  parenchyma  and  to  the  fact  that  it  is 
composed  of  lymphoid  tissue  any  rough  handling  either  of  the 
normal  or  of  the  abnormal  organ  is  to  be  condemned,  though 
careful  pressure  is  not  dangerous.  The  usual  lesions  associ- 
ated with  the  disease  are  found  in  the  upper  chest  and  lower 
cervical  regions. 

The  various  vascular  and  nervous  structures  have 
been  mentioned  in  discussing  the  muscles.  The  external 
jugular  vein  with  the  associated  superficial  lymphatic  vessels 
and  glands  crosses  the  sterno-mastoid  in  a  vertical  direction. 
This  and  the  other  vessels  referred  to  often  give  valuable 
hints  with  reference  to  the  condition  of  the  heart  action.  The 
inferior  thyroid  vessels  may  be  noticed  in  some  cases  where  a 


234  PRINCIPLES    OF   OSTEOPATHY. 

supra- thoracic  crowding  ia  interfering  with  their  function. 
The  ph rente  nerve  passes  down  over  the  scaleni  muscles  from 
its  mid  cervical  formation,  into  the  region  of  the  chest.  Cerv- 
ical lesions  often  irritate  its  roots  and  obstinate  hiccough 
result.  The  nerve  can  be  more  or  less  directly  reached  by 
pressure  downward  and  inward  in  the  angle  formed  by  the 
junction  of  the  sterno-mastoid.  with  the  anterior  end  of  the 
clavicle,  or  occasionally  pressure  downward  and  outward  in 
the  depression  above  the  sternum.  Thz  gangliated  cord  may 
be  reached  indirectly  by  pressure  applied  to  the  front  of  the 
transverse  processes  of  the  vertebrae.  The  wisdom  of  such 
pressure  is  decidedly  open  to  question  since  more  harm  than 
good  will  usually  result. 

THE  CERVICAL  VERTEBRAE. 

These  vertebrae  are  peculiar  from  several  standpoints. 
Their  greater  mobility  which  renders  them  more  susceptible  to 
luxation,  the  .variety  in  the  formation  of  the  several  bones, 
and  their  closer  relation  to  the  important  medullary  centers 
make  a  detailed  discussion  imperative  for  a  clear  understand- 
ing of  the  numerous  disorders  that  may  arise  from  a  cervical 
lesion,  and  a  proper  appreciation  of  the  effects  secured  by 
adjustment  of  the  cervical  tissues. 

In  making  an  examination  of  the  vertebrae  it  is  often 
necessary  to  produce  as  complete  a  relaxation  as  is  possible, 
and  hence  after  noting  the  various  peculiarities  that  may  be 
presented  while  the  head  is  held  erect,  the  patient  should  as- 
sume the  horizontal  posture.  Then  by  a  quiet  series  of  roll- 
ing of  the  head  from  side  to  side  together  with  pressure  and 
other  methods  for  temporary  relaxation,  the  patient  will  be 
in  a  proper  condition  for  minute  examination  of  the  deeper 
structures.  The  flat  of  the  hand  should  be  laid  careful- 
ly upon  the  an tero- lateral  and  postero- lateral  aspects  and 
while  rolling  the  head  to  the  side  pressure  is  exerted  in  a 
direction  opposite  to  the  movement  of  the  head.  Or,  stand- 
ing at  the  head  of  the  patient  and  clasping  the  postero-lateral 


CERVICAL   LESIONS — DIAGNOSIS  AND  TREATMENT.  235 

structures  on  each  side  the  neck  may  be  quietly  manipulated 
sufficient  to  temporarily  relax.  In  some  cases  where  there  is 
an  inflammatory  or  makedly  congested  condition  of  the  neck 
and  throat  muscles  it  may  be  painful  to  apply  much  direct 
pressure  to  the  parts.  In  such  case  the  writer  has  found  the 
following  method  satisfactory  especially  in  cases  associated 
with  much  lymphatic  enlargement  and  inflammation.  Stand- 
ing at  the  head  of  the  patient  grasp  the  chin  with  one  hand, 
the  occiput  with  the  other,  then  keeping  the  axis  of  the  head 
parallel  to  the  axis  of  the  body,  rotate  the  head  through  a 
complete  circle  and  reverse.  A  few  rotations  thus  applied 
slowly  will  open  up  the  deeper  structures  and  produce  con- 
ditions that  will  quite  appreciably  lessen  the  tension  and  sen- 
sitiveness so  that  further  examination  becomes  possible. 

Having  gotten  the  superficial  tissues  relaxed  several  impor- 
tant points  are  noticed  with  reference  to  the  nature  and  rela- 
tions of  the  cervical  vertebrae.  Note  that  in  the  erect  position 
there  will  be  a  distinct  anterior  convexity,  so  much  so  that  the 
spines  of  the  third,  fourth,  and  fifth  will  be  only  with  diffi- 
culty made  out.  The  considerable  mobility  of  this  part  of  the 
spine  in  comparison  with  other  regions  will  be  another  strik- 
ing fact  and  any  rigidity  not  dependent  upon  a  voluntary 
though  unconscious  contraction  of  the  cervical  muscles  sug- 
gests a  thickened  ligamentous  condition.  Rolling  the  head 
from  side  to  side,  showing  a  difference  in  the  comparative 
amount  of  rotation,  is  a  method  of  value  to  determine  the  lesion. 
The  flexion  of  the  head  strongly  forward  on  the  chest  should 
not  be  associated  with  much  discomfort  in  the  average  in- 
dividual. If  the  latter  be  produced  lesion  is  indicated.  This 
same  method  should  throw  the  vertebras  sufficiently  posterior 
to  enable  one  to  detect  the  spines  with  the  exception  of  that 
of  the  atlas.  In  many  cases  the  spinous,  the  transverse,  and 
the  articular  processes  of  each  of  the  vertebrase  can  be  made 
out  without  great  difficulty.  It  is  usually  stated  that  the 
rudimentary  spine  of  the  first  cervical  cannot  be  detected. 
Yet  if  sufficient  care  be  taken  with  reference  to  a  preliminary 


236  PRINCIPLES   OF  OSTEOPATHY. 

relaxation,  that  process  can  be  detected  in  twenty -five  percent  of 
cases.  By  gradually  insinuating  the  finger  in  the  depression 
between  the  occiput  and  the  spine  of  the  axis  after  a  prelimi- 
nary relaxing  treatment,  the  spine  will  be  felt  as  a  definite 
tubercle  deeply  within  the  tissue.  But  in  most  cases  reliance 
must  be  made  on  the  transverse  processes  and  the  surrounding 
tissues  for  the  determination  of  the  situation  and  condition  of 
the  atlas.  The  transverse  processes  will  be  detected  between 
the  angle  of  the  jaw  and  the  mastoid  process  of  the  temporal 
bone,  varying  within  rather  wide  limits  with  individuals.  In 
most  cases  they  are  easily  detected  but  in  a  few  there  may  be 
considerable  difficulty  in  locating  them  owing  to  the  condition 
of  the  tissues  and  the  development  of  the  processes.  It  would 
seem  that  the  transverse  processes  of  the  atlas,  more  than 
the  similar  processes  of  others,  are  subject  to  great  variation 
in  relative  position,  size,  and  shape.  Not  only  that  but  in  half 
the  cases  examined  there  will  be  a  difference  in  size,  perhaps 
in  shape,  between  the  two  processes  of  the  same  atlas.  Hence 
the  physician  should  be  on  his  guard  against  a  hasty  judg- 
ment with  reference  to  the  nature  of  the  atlas  lesion. 

All  things  considered,  the  most  satisfactory  position  for 
examining  the  atlas  is  the  horizontal  one  with  the  examiner 
standing  at  the  head  of  the  table.  Applying  the  surface  of 
the  index  fingers  gently  on  either  side  underneath  the  angle 
of  the  inferior  maxillary,  careful  pressure  is  exerted  toward 
the  median  line.  In  most  cases  the  fingers  will  soon  come  in 
contact  with  the  ends  of  the  processes.  If  they  are  not  im- 
mediately felt  take  time  and  allow  the  fingers  and  tissues  to 
become  accustomed  to  each  other,  then  with  careful  explora- 
tion in  all  directions  the  processes  will  be  detected.  In  some 
cases  they  will  be  found  rather  underneath  or  even  behind  the 
mastoid  process.  In  others  they  will  be  forward  and  above  a 
line  passing  through  the  most  prominent  part  of  the  angles  of 
the  inferior  maxillary.  In  many  cases  they  will  stand  out  on 
a  level  with  the  mastoid  or  the  jaw,  while  in  others  they  will 
be  so  deeply  situated  as  to  be  reached  only  with  difficulty.  By 


CERVICAL   LESIONS — DIAGNOSIS   AND  TREATMENT.  237 

comparison  of  the  ends  of  the  transverse  processes  on  either 
side  with  the  mastoid,  maxillary,  and  other  points  of  promi- 
nence, it  can  be  determined  whether  there  be  a  lateral,  a 
twisted,  a  tipped,  or  otherwise  distorted  condition.  Examine 
along  the  postero-lateral  arches  of  the  atlas.  While  these  arches 
cannot  be  directly  reached  the  overlying  tissues  will  almost 
invariably  indicate  a  lesion  by  their  soreness,  congested  and 
contractured  condition.  In  the  region  of  the  transverse  pro- 
cesses tenderness  and  density  of  tissue  will  usually  be  mani- 
fest. Even  in  normal  conditions  the  region  of  the  transverse 
processes  will  usually  be  rather  sensitive  and  hence  care 
should  be  exercised  in  examining  the  part  and  in  forming 
conclusions  based  on  the  sensory  condition.  In  most  cases 
one  side  will  present  a  more  marked  sensory  disturbance  and 
that  side  will  usually  be  the  one  toward  which  the  vertebra 
is  displaced.  The  movements  that  normally  may  take  place 
between  the  atlas  and  the  occiput  are  flexion,  extension,  and 
a  lateral  sliding,  and  in  case  a  lesion  is  present  it  may  be  an 
extreme  of  any  one  or  more  of  these.  In  many  cases  there 
will  be  a  direct  lateral  condition  with  reference  to  the  occiput, 
but  an  approximately  normal  position  with  reference  to  the 
other  vertebrae,  in  which  case  the  condition  is  more  appro- 
priately a  subluxation  of  the  occiput.  In  other  cases  it  will 
be  distorted  with  reference  to  both.  A  tipped  condition  is  a 
fairly  common  one.  This  is  dependent  usually  on  a  greater 
muscular  tension  on  one  side  than  on  the  opposite.  A  common 
condition  is  a  tightened  posterior  musculature  which  draws  the 
posterior  arch  upward  in  close  proximity  to  the  occiput.  Or 
one  side  will  be  more  closely  approximated  and  the  level 'be  dis- 
turbed. A  torsion  is  often  met  with.  This  is  indicated  by  the 
anterior  position  of  one  transverse  process  in  comparison  with  a 
posterior  position  of  the  other.  The  whole  vertebra  may  be 
somewhat  anterior  or  posterior  with  reference  to  the  occiput 
but  can  go  only  inappreciably  posteriorly  with  reference  to 
the  axis,  owing  to  the  relation  between  the  atlas  and  the  odon- 
toid process  of  the  axis.  Yet  it  is  illogical  to  affirm  that  it  is 


238  PRINCIPLES   OF   OSTEOPATHY. 

absolutely  impossible.  No  change  is  impossible  provided  the 
force  shall  act  sufficiently  long  or  sufficiently  intense.  With 
reference  to  the  disturbance  between  the  atlas  and  axis,  the 
condition  is  more  commonly  a  torsion,  rotation  being  the  most 
marked  normal  movement  and  accounting  for  most  of  the 
rotation  in  the  cervical  region.  Lateral  subluxations  are  also 
common,  while  the  other  possible  conditions  are  occasionally 
observed. 

In  examination  of  the  axis  several  landmarks  present 
themselves.  The  prominent  spinous  process  whose  bifid  nature 
is  usually  easily  detected  affords  much  information.  Care 
must  be  exercised  in  forming  conclusions  from  observation  of 
this  structure  since  because  of  its  large  size  it  is  quite  subject 
to  variation  in  its  growth.  It  is  perhaps  normally  more  de- 
veloped on  the  side  of  the  body  which  is  used  the  most,  and 
hence  in  examination  of  this  as  in  other  vertebrae  it  is  always 
wise  to  inquire  if  the  patient  be  right-handed  or  left-handed. 
The  transverse  and  articular  processes  afford  further  opportuni- 
ty for  examination.  The  former  will  usually  be  found  on  a 
level  with  the  spinous  process  underneath  and  behind  the 
transverse  process  of  the  atlas.  In  some  cases  some  difficulty 
will  be  encountered  but  usually  the  prominence  will  be  suffi- 
ciently marked.  The  lesions  associated  with  the  axis  are  in 
general  the  same  as  those  mentioned  in  connection  with  the 
atlas  and  will  be  detected  by  a  comparison  of  the  several 
points  of  prominence  of  the  adjacent  vertebrae,with  the  further 
notice  of  conditions  of  tenderness,  contracture,  and  other 
states  indicating  lesion. 

In  examination  of  the  third  to  the  fifth  inclusive,  a 
few  additional  facts  should  be  noticed.  In  the  erect  position 
the  normal  individual  will  present  an  anterior  convexity  but 
in  the  supine  posture  the  curvature  may  be  obliterated.  In 
either  position  manipulation  will  show  marked  mobility  in  an 
antero-posterior  direction.  In  many  cases  if  the  finger  be 
pressed  horizontally  across  the  spine  of  the  fourth  cervical, 
strong  pressure  of  the  head  back  upon  the  finger  will  produce 


CERVICAL  LESIONS — DIAGNOSIS  AND  TREATMENT.  239 

actual  pinching  of  the  finger  between  the  spinous  processes 
of  the  second  and  sixth.  In  the  diagnosis  of  lesion  reliance  is 
made  upon  the  position  and  condition  of  the  transverse  and 
articular  processes.  The  former  are  the  more  subject  to  nor- 
mal variations  in  size  and  shape  and  hence  are  not  as  satis- 
factory as  are  the  latter.  Further,  owing  to  their  irregular 
nature  and  the  fact  that  very  delicate  structures  lie  immediate- 
ly in  front — i.  e.,  the  deep  cervical  vessels,  sympathetic  cord, 
and  trunks  of  the  spinal  nerves — greater  care  must  be  exer- 
cised or  harm  may  be  done  in  pressing  down  upon  them.  The 
row  of  transverse  process  are  noticed  if  pressure  be  applied 
in  front  oi  the  sterno-mastoid  muscle,  backward  and  toward 
the  median  line,  except  in  the  lower  part  of  the  neck  where 
they  may  be  reached  behind  that  muscle.  On  the  other  hand 
if  pressure  be  made  behind  the  sterno-mastoid,  forward  and 
toward  the  median  line  the  row  of  articular  processes  will  be 
felt.  The  articular  processes — less  markedly  the  transverse- 
will  appear  as  Bridge  of  bony  tissue  presenting  regularly  dis- 
tributed prominences.  The  latter  represent  the  junction  of 
two  adjacent  processes.  It  is  at  these  points  that  prominence 
and  pain  will  be  most  noticed  if  lesion  is  present.  Then  by 
reference  to  the  other  considerations  of  the  lesion  judgment 
may  be  made  respecting  the  nature  of  the  part  under  sus- 
picion. The  depth,  an tero- posteriorly,  of  the pharyngeal  cavity, 
will  be  a  point  of  interest  in  diagnosis  of  antero -posterior 
swerves  of  the  cervical  vertebrae,  the  posterior  wall  of  the 
pharynx  being  formed  of  the  bodies  of  the  upper  cervicals 
overlaid  with  connective,  muscular,  and  mucous  tissue. 

The  sixth  cervical  is  noticeable  because  of  close  approxi- 
mation of  its  spinous  process  to  the  superior  surface  of  that 
of  the  seventh.  The  seventh  is  detected  by  its  prominent 
spine  which,  though  usually  stated  to  be  less,  is  often  equally 
as  protruding  as  the  spine  of  the  first  thoracic.  The  transverse 
process  of  the  seventh  is  usually  felt  just  above  and  a  trifle  in 
front  of  the  junction  of  the  first  rib  with  the  process  of  the 
first  thoracic.  In  many  individuals  a  considerable  mass  of 


240  PRINCIPLES   OF   OSTEOPATHY. 

muscular  and  other  tissues  in  this  region  makes  its  detection 
somewhat  difficult.  By  reference  to  the  spinous  process  of 
the  seventh  which  is  on  a  slightly  lower  level  aid  will  be  given. 
Rotation  and  flexion  oi  the  head  on  the  neck  in  various  ways 
will  assist  in  determining  the  distinction  between  the  spine  of 
the  la<st  cervical  and  the  first  dorsal.  Owing  to  the  greater 
amount  of  tissue  associated  and  the  articulation  with  the  rib, 
there  will  be  noticeably  less  movement  between  the  first  and 
second  thoracic  than  between  the  last  cervical  and  first 
thoracic. 

ADJUSTMENT  OF  CERVICAL  VERTEBRAE. 

The  general  principles  underlying  the  adjustment  of  the 
bony  lesion  have  been  referred  to  in  a  previous  section. 
Briefly  they  are  exaggeration  of  the  lesion,  rotation,  and  pres* 
sure  upon  the  part.  In  many  cases  a  preliminary  relaxation 
is  advisable  while  in  a  few  relaxation  may  be  the  only  treat- 
ment necessary.  In  general  acute  cases  require  more  relaxa- 
tion than  do  those  of  a  chronic  nature.  Personally,  in  most 
cases  of  the  latter,  the  writer  gives  but  little  attention  to  pre- 
liminary relaxation,  but  often  follows  the  direct  vertebral 
treatment  by  a  quiet  soothing  pressure.  In  the  average 
chronic  case  a  slight  movement  of  the  vertebra  toward  its 
normal  position  is  all  that  is  desired,  and  that  can  be  suffi- 
ciently accomplished  without  previous  relaxation.  At  least  the 
preliminary  treatment  will  be  only  temporary  in  its  effect  on 
the  muscle  and  as  soon  as  the  relaxive  process  is  withheld 
the  muscle  again  begins  to  contract.  Note  that  a  chronic  con- 
tracture  is  usually  direct  evidence  of  a  deeper  lesion  and  that  lesion 
is  one  that  is  shutting  off  normal  interchange  between  the 
muscle  and  its  sources  of  supply.  The  relaxive  treatment 
applied  after  attempts  to  adjust  the  deeper  parts  is  for  the 
purpose  of  overcoming  any  excess  of  contracture  or  irritation 
that  has  arisen  because  of  the  stimulus  from  treatment. 

A  few  specific  cases  will  be  given  to  illustrate  the  prin- 
ciples back  of  all  movements  designed  to  correct  cervical 


CERVICAL  LESIONS — DIAGNOSIS   AND  TREATMENT.          241 

disorder.  A  right  lateral  atlas  is  diagnosed.  With  patient 
on  his  back  the  physician  stands  at  the  head  of  the  table  with 
the  fingers  of  each  hand  similarly  disposed,  clasping  the  tis- 
sues along  the  region  of  the  postero-lateral  arches  of  the  atlas ; 
at  the  same  time  the  thumbs  may  be  placed  on  the  transverse 
processes.  Exaggerate  the  lesion  by  thrusting  with  the  left 
hand  directly  to  the  right  the  tissues  over-lying  the  lateral 
arches ;  at  the  same  time  the  head  of  the  patient  is  pressed 
against  the  abdomen  of  the  physician  with  sufficient  force  to 
give  steadiness  of  movement.  Then  with  exactly  the  reverse 
process  pressure  is  applied  over  the  right  lateral  arch  and  ro- 
tation is  effected  by  movement  of  the  hands  and  body  of  the 
physician.  Do  not,  in  exaggeration  of  the  lesion,  merely 
bend  the  head  in  the  direction  opposite  to  the  displacement, 
as  that  will  tend  to  diffuse  the  exaggeration  over  a  larger  area. 
Further,  except  in  obstinate  cases,  do  not  use  much  pressure  up- 
on the  transverse  processes.  This  region  is.  always  tender  and  in 
lesion  conditons  is  makedly  so,  hence  the  pressure  may  cause 
enough  irritation  to  result  in  increased  tightening  of  tissues. 
In  nearly  all  cases  enough  lateral  pressure  for  the  purpose 
can  be  exerted  on  the  lateral  arches  whose  sensory  condition 
will  not  be  so  disturbed. 

Another  method  which^has  certain  advantages  is  ap- 
plied with  the  patient  in  the  same  position  and  with  the  ex- 
aggeration, rotation,  and  pressure  produced  in  the  same  way 
except  that  one  hand  of  the  physician  with  fingers  on  one 
side  and  thumb  on  the  opposite  clasps  the  postero-lateral 
arches ;  with  the  other,  which  is  placed  upon  the  crown  of  the 
head,  manipulation  is  made  for  purposes  of  rotation.  Or 
with  the  head  of  the  patient  against  the  abdomen  of  the 
physician,  the  free  hand  grasps  the  chin  for  the  purpose  of 
manipulation  and  rotation.  In  all  of  these  movements  pres- 
sure is  exerted  downward  upon  the  head  in  the  direction  of 
the  axis  of  the  spinal  column  in  order  to  keep  the  muscles  and 
other  tissues  as  lax  as  is  possible,  although  the  treatment 
may  \>Q  finished  by  slight  longitudinal  traction.  This  latter 


242  PRINCIPLES   OF   OSTEOPATHY. 

movement  should  not  be  used  with  too  much  force  and  should 
be  a  straight  pull,  not  a  jerking  or  twisting  movement. 

The  same  principles  as  the  foregoing  may  be  employed 
to  advantage  with  the  patient  in  the  sitting  posture.  With 
the  forehead  of  the  patient  resting  against  the  chest  of  the 
physician  the  upper  cervical  tissues  may  be  clasped  by  the 
fingers  on  either  side  of  the  atlas.  Then  by  the  chest  and 
hands  together  and  assisted  by  application  of  the  chin  of  the 
physician  to  the  crown  of  the  patient's  head,  rotation  and 
movement  can  be  effected  in  any  direction.  Or  with  the  patient 
sitting  erect,  the  physician  standing  at  the  side  places  one 
hand  on  the  crown  of  the  head  for  purposes  of  rotation  while 
with  the  other  the  cervical  tissues  are  clasped  in  the  usual 
manner.  In  case  of  a  twisted  atlas  some  pressue  may  be  ap- 
plied to  the  transverse  processes  in  the  direction  to  effect 
restoration ;  while  in  anterior  lesions  it  may  be  necessary  to  get 
the  fingers  somewhat  in  front  of  the  processes  to  exert  a 
backward  pressure.  Bending  the  head  strongly  forward  and 
pressing  downward  while  at  the  same  time  working  the  part 
from  side  to  side  in  many  cases  effects  an  adjustment  of  the 
anterior  condition. 

All  of  these  various  treatments  can  be  easily  applied  and 
with  equal  or  greater  success  to  other  of  the  cervical  ver- 
tebrae. Owing  to  their  less  obstructed  situations  direct  pres- 
sure may  be  gotten  upon  most  parts  of  the  bones  and  hence 
pressure  may  be  exerted  without  hindrance  in  the  direction 
the  part  should  go  in  order  to  re -assume  its  normal  position. 
In  most  cases  it  will  not  be  advisable  or  necessary  to  exert 
pressure  upon  the  transverse  processes.  The  articular  and 
spinous  processes  and  associated  tissue  being  sufficiently 
prominent  the  part  may  be  moved  at  will.  Strong  but  care- 
ful rotation  of  the  head  to  either  side  is  of  advantage  not  only 
in  detecting  various  lesion  conditions  but  also  in  overcoming 
the  deep  ligamentous  or  muscular  thickenings.  Flexion  of 
the  head  on  the  chest  will  tend  to  draw  any  of  the  cervical 
vertebrae  in  a  posterior  direction.  (See  Fig.  21).  This  will 


CERVICAL   LESIONS — DIAGNOSIS  AND   TREATMENT.  243 

be  more  true  with  reference  to  the  sixth  and  seventh  cervicals 
to  which  the  ligamentum  nuchae  is  more  directly  attached;  if 
at  the  same  time  lateral  pressure  be  applied  to  the  spinous 
process  alternately  in  each  direction  these  two  vertebrae  can 
be  very  considerably  affected. 

THE  INFERIOR  MAXILLARY  BONE. 

The  inferior  maxillary  is  a  structure  deserving  more 
notice  from  the  osteopath  than  its  apparent  functions  would 
seem  to  justify.  By  virtue  of  the  close  relations  existing  be- 
tween the  articular  structures  of  the  condyle  and  certain  im- 
portant nervous,  muscular,  and  glandular  structures,  it  is 
often  found  associated  in  a  causal  relation  with  various  local 
disorders.  In  making  the  examination  the  two  general 
principles  already  referred  to  should  be  remembered  i.  e.,  ex- 
amining the  part  during  functional  activity  and  functional 
rest.  The  normal  movement  of  the  bone  is  a  complex  one  in- 
volving several  sets  of  muscles,  the  elements  of  the  movement 
being  a  vertical,  a  lateral,  and  an  antero- posterior  change  in 
position.  In  examining  the  part  in  activity  the  patient  should 
lie  supine  upon  the  table  with  the  physician  standing  at  the 
head.  Then  directing  the  patient  to  open  and  close  the  mouth 
note  should  be  taken  whether  the  mid -point  of  the  chin  de- 
viates from  the  median  line.  In  numerous  cases  it  will  be  seen 
on  opening  the  mouth  to  swing  to  one  side,  which  usually  in- 
dicates a  difference  in  the  tension  of  the  muscular  or  liga- 
mentous  structures  between  the  two  sides,  the  deviation  being 
toward  the  side  of  greater  tension.  This  usually  will  depend  on 
a  pathological  condition  of  the  tissues  on  the  side  of  greater 
tension  but  in  occasional  cases  the  lax  articulation  is  the  ab- 
normal one.  If  now  the  fingers  of  the  physician  be  inserted 
deeply  behind  the  ascending  rami  the  greater  tension  of  the 
one  side  will  become  quite  apparent.  During  the  process  of 
movement  of  the  jaw  note  should  be  taken  of  the  sounds  quite 
often  produced  in  the  articulation.  These  sounds  are  similar 
to  those  produced  by  pressure  on  the  ribs  at  the  transverse  ar- 


244  PRINCIPLES   OF   OSTEOPATHY. 

ticulations  or  in  the  cervical  vertebrae  on  rotation  of  the  head. 
In  many  cases  it  will  be  heard  only  on  the  one  side  and  that 
the  side  of  greater  laxity.  In  others  the  sound  seems  to  be 
produced  equally  on  the  two  sides  and  in  most  cases  will  be 
more  marked  in  those  individuals  whose  other  articulations 
are  unusually  lax.  In  many  cases  of  these  the  condition  would 
seem  to  be  a  normal  one,  at  least  in  so  far  as  other  evidence 
of  disorder  is  concerned. 

The  lesions  associated  with  the  inferior  maxillary  con- 
stitute simple  tension  conditions  of  the  articular  structures  and 
partial  or  complete  luxation  of  one  or  both  sides  of  the  bone. 
The  movement  of  the  articular  surface  of  the  condyle  upon 
that  of  the  temporal  bone  is  a  complex  one.  One  movement 
consists  in  a  simple  sliding  forward  of  the  condyle  to  the  an- 
terior part  of  the  articular  surface  which  terminates  upon  the 
postero- inferior  part  of  the  articular  eminence.  In  some  cases 
of  lesion  it  would  seem  that  the  condyle  on  one  or  both  sides 
were  resting  directly  upon  this  eminence.  In  other  cases  the 
subluxation  consists  in  a  lateral  sliding  of  the  bone  as  a  whole. 
In  these  two  types  the  part  presumably  is  held  in  its  abnormal 
position  by  muscular  and  ligamentous  contracture.  In  a 
.complete  dislocation  the  condyle  will  rest  upon  the  articular 
eminence  or  more  or  less  completely  in  front  of  it,  in  which 
case  the  mouth  will  be  forcibly  prevented  from  closing. 
Where  the  dislocation  is  a  unilateral  one  the  symptoms  are 
not  so  marked  and  there  is  more  or  less  possibility  of  move- 
ment. It  is  with  the  subluxations,  however,  that  the  osteo- 
path has  most  to  do. 

The  treatment  of  the  inferior  maxillary  usually  resolves 
itself,  in  the  case  of  the  slight  subluxations,  into  overcoming 
the  tightened  muscular  and  ligamentous  conditions.  This 
means  that  in  many  cases  definite  lesions  will  be  associated ' 
with  the  upper  cervical  region  which  cause  the  disturbance 
of  the  nutrition  of  the  articular  structures.  It  is  often  suffi- 
cient to  make  use  of  a  few  so-called  specific  treatments  grouped 
under  the  general  head  of  "springing  the  jaw."  The  artic- 


CERVICAL  LESIONS— DIAGNOSIS  AND   TREATMENT.  245 

ulation  can  be  affected  by  having  the  patient  open  the  mouth 
against  resistance.  This  is  accomplished  satisfactorily  in  the 
following  manner:  The  physician  standing  at  the  head  of 
the  table,  places  the  palms  of  the  hands  on  the  malar  emi- 
nences and  with  the  fingers  grasps  the  point  of  the  chin ;  then 
holding  the  mouth  closed  the  patient  is  directed  to  open  it. 
The  articulation  will  thus  be  loosened  through  the  action  of  a 
lever  of  the  third  class  in.  which  the  chin  is  the  fulcrum,  the  re- 
sistance of  the  articular  structures  the  weight,  while  the 
power  is  applied  through  the  digastric  and  other  muscles 
passing  from  the  hyoid  bone  to  the  horizontal  ramus  of  the 
jaw  near  its  anterior  extremity.  Placing  a  dense  substance 
between  the  molar  teeth  and  then  approximating  the  incisors 
by  pressure  upward  on  the  chin  will  produce  a  similar  effect 
through  a  leverage  of  the  first  class.  A  third  method  producing 
similar  results  consists  in  closing  the  mouth  against  resist- 
ance. In  this  movement  the  fingers  of  the  physician  are  in- 
serted, while  the  patient's  mouth  is  open,  into  the  depression 
in  front  of  the  auditory  canal  caused  by  the  lowered  coronoid 
process.  Owing  to  the  painfulness  of  the  treatment  the 
author  is  personally  opposed  to  its  use.  Another  method  in 
which  opening  the  mouth  against  resistance  is  employed, 
forces  the  condyle  upward  and  forward.  In  this  the  move- 
ment is  similar  to  the  one  first  described  except  that  the 
fingers  are  applied  near  the  angle  of  the  jaw  or  at  least  at  a 
point  posterior  to  the  insertion  of  the  muscles  that  depress 
the-  bone. 

Among  the  effects  of  these  various  forms  of  inferior 
maxillary  lesions,  are  neuralgias  associated  with  branches  of 
the  fifth  cranial  with  which  the  articulation  and  other  parts 
of  the  jaw  are  in  connection;  ear  aches  are  common  effects  of 
subluxated  conditions  of  the  bone ;  throat  and  tonsil  disorders 
are  often  noted  while  disordered  conditions  of  the  parotid 
gland  may  result  owing  to  its  approximation  to  the  ascending 
ramus. 


246  PRINCIPLES   OF   OSTEOPATHY. 


CHAPTER  XII 


CERVICAL  LESIONS— EFFECTS. 

The  disordered  states  that  by  observation  have  been 
found  to  depend  on  cervical  lesions  are  extremely  numerous 
and  varied.  It  is  theoretically  if  not  practically  true  that  any 
organ  or  tissue  of  the  body  may  be  made  to  suffer  by  inter- 
ference in  this  region ;  it  is  not  the  purpose  of  this  section  to 
speak  of  all  possible  conditions,  but  those  more  commonly 
associated  and  which  present  a  reasonable  relation  to  the 
known  anatomical  and  physiological  facts  in  connection  with 
the  region. 

EFFECTS  FROM  DIRECT  PRESSURE. 

In  a  previous  section  several  ways  were  specified  in  which 
a  lesion  may  affect  an  organ,  viz.,  by  direct  pressure  upon  it, 
or  impingement  on  artery,  vein,  lymphatic,  or  nerve  mechan- 
ism associated  with  it.  Through  these  several  media  the  cer- 
vical lesion  produces  its  effects.  Few  definite  organs  are 
closely  enough  associated  with  the  cervical  structures  to  suffer 
from  direct  pressure  but  those  few  are  of  some  considerable 
importance.  It  is  stated  that  the  spinal  cord  may  suffer 
from  direct  pressure  in  case  of  a  luxated  vertebra.  Manifestly 
such  a  case  must  be  rare,  since  a  lesion  sufficient  to  reach 
through  the  protecting  coverings  of  the  cord  must  be  in  the 
nature  of  a  complete  dislocation  of  the  vertebra.  It  is  known 
that  there  are  such  cases  several  of  which  have  been  treated 
by  osteopaths  and  with  success.  A  condition  as  severe  must 
be  profound  in  its  effects,  and  such  is  true  of  the  observed 
cases,  a  complete  or  partial  paralysis  resulting  in  the  parts 
supplied  from  the  cord  below  the  lesion.  The  old  school 
physicians  recognize  such  possibilities.  Hilton  instances  a 


CERVICAL  LESIONS — EFFECTS.  247 

case  or  two  where  by  a  diseased  or  weakened  condition  of  the 
ligaments  supporting  the  odontoid,  that  process  was  allowed 
to  fall  back  producing  more  or  less  direct  pressure  upon  the 
cord.  In  these  cases  a  fatal  termination  followed.  In  death 
from  hanging  the  effect  comes  from  the  forcible  rupture  of 
the  supporting  ligaments  of  the  odontoid  which  causes  the 
latter  to  exert  direct  pressure  upon  the  cord.  It  is  not  difficult 
to  conceive  of  a  less  intense  result  to  follow  a  less  serious  weakening 
of  these  same  connecting  structures  from  faulty  nutrition; 
but  in  most  such  cases  it  is  more  reasonable  to  assume  that 
the  effect  follows  because  of  impingement,  not  directly  on  the 
cord,  but  upon  the  vascular  and  other  structures  which  are 
concerned  in  keeping  the  cord  in  a  normal  condition  of  metab- 
olism. 

The  thyroid  gland  may  suffer  from  an  anterior  crowd- 
ing of  the  lower  cervical  region,  thereby  putting  the  adjacent 
tissues  on  irritation  and  tension.  The  sympathetic  ganglia 
may  suffer  in  like  manner  from  vertebral,  ligamentous,  or 
muscular  lesion.  A  discussion  of  the  latter  more  properly 
comes  under  another  section  for  which  it  will  be  reserved. 

EFFECTS  FROM  VASCULAR  OBSTRUCTION. 

Among  the  effects  of  cervical  lesions  many  are  readily 
explained  by  reference  to  the  obstruction  of  arteries,  veins, 
and  lymphatic  vessels  which  connect  with  the  various  organs. 
Among  these  we  may  speak  at  some  length  of  the  carotid, 
vertebral,  and  thyroid  arterial  systems  with  their  associated 
venous  and  lymphatic  channels. 

The  carotid  artery  passes  from  the  cervico- thoracic 
junction  behind  the  articulation  of  the  sternum  with  the 
clavicle  to  pass  upward  toward  a  point  midway  between  the 
angle  of  the  inferior  maxillary  and  the  mastoid  process  of  the 
temporal  bone,  dividing  on  a  level  with  the  superior  margin 
of  the  thyroid  cartilage  and  fourth  cervical  vertebra  into  the 
external  branch  which  passes  on  to  supply  the  extra-cranial 
structures,  and  the  internal  which,  passing  through  the  ca- 


248  PRINCIPLES   OF   OSTEOPATHY. 

rotid  canal,  is  distributed  to  the  various  intra- cranial  struct- 
ures. In  its  cervical  course  it  lies  between  the  sterno-mas- 
toid,  sterno-thyroid,  sterno-hyoid,  omo-hyoid,  and  platysma 
myoides  on  the  external  aspect,  and  the  scalenus  anticus  and 
longus  colli  muscles,  the  trachea,  larynx,  thyroid  gland, 
esophagus  and  pharynx  on  the  posterior  and  internal  aspects. 
It  will,  then,  be  more  or  less  subject  to  obstruction  by  contrac- 
ture  or  other  abnormal  condition  of  one  or  more  of  these  vari- 
ous structures.  Note  should  be  taken  of  the  fact  that  a  lobe 
of  the  thyroid  gland  often  overlays  the  artery  and  in  enlarged 
and  hardened  states  of  that  organ  it  may  offer  serious  impedi- 
ment to  normal  flow.  By  virtue  of  a  narrowed  cervico- thoracic 
junction  serious  hindrance  may  be  caused  to  the  flow  from  the 
deeper  arteries  from  which  the  carotid  arises,  with  not  only 
a  disorder  in  the  parts  supplied  by  its  branches  but  also  im- 
pairment of  the  integrity  of  the  heart's  action.  The  further 
distribution  of  the  branches  of  the  external  cartoid  in  and 
among  the  muscles  and  other  structures  of  the  face  and 
infra-maxillary  region  gives  rise  to  numerous  possibilities  of 
impairment  of  blood  flow  when  those  structures  are  in  a  con- 
dition of  lesion.  The  corresponding  venous  and  lymphatic  ves- 
sels are  similarly  disposed  with  reference  to  the  structures  in- 
volved in  lesion  and  hence  interference  with  lymph  supply 
and  venous  drainage  may  produce  numerous  disorders  re- 
sulting from  congestion  and  infiltration  of  the  various  organs. 
Hence,  various  disorders  dependent  on  venous  congestion 
and  arterial  anaemia  may  result  from  contracture  and  other 
forms  of  lesion  associated  with  the  cervical  region.  These 
may  be  in  relation  to  any  part  to  which  the  vascular  struc- 
tures are  distributed,  i.  e.,  eye  and  ear  affections,  headaches 
dependent  on  cranial  congestions  or  anaemias,  or  on  similar 
conditions  of  the  scalp;  facial  eruptions,  hair  malnutrition ; 
diseases  of  the  throat,  the  nasal  passages,  and  the  deep 
and  superficial  structures  of  the  neck,  especially  the  upper 
part.  Notice  that  in  general  the  venous  and  lymphatic  ves- 
sels accompany  the  arterial  trunks  and  hence  any  lesion  suffi- 


CERVICAL  LESIONS— EFFECTS.  249 

dent  to  involve  one  will  be  likely  to  involve  the  others^  so  that  the 
total  ill  effect  will  be  greater  in  the  part  than  would  result 
from  obstruction  to  a  single  one  of  the  systems.  For  instance 
pressure  exerted  by  the  tightened  structures  in  the^region  of 
the  jugular  foramen  will  likely  affect  the  branches  of  the  ca- 
rotid artery  and  tributaries  of  the  jugular  vein  with  a  result- 
ing condition  of  in  tra- cranial  arterial  anaemia  and  venous 
hypersemia.  Note  further  that  the  pressure  will  affect  the  venous 
flow  more  markedly  than  the  arterial,  owing  to  the  more  yield- 
ing nature  of  the  venous  wall;  hence  while  the  arterial  blood 
will  not  enter  the  cavity  sufficiently  rapid  to  maintain  normal 
nutrition,  it  will  pass  inward  more  rapidly  than  the  venous 
blood  can  return,  with  the  result  that  a  venous  congestion 
will  be  added  to  the  arterial  anaemia. 

The  second  of  the  vascular  systems  likely  to  suffer  from 
cervical  lesion  is  the  vertebral.  The  vertebral  artery  aris- 
ing from  the  subclavian  passes  upward  and  outward  to  enter 
the  foramen  in  the  transverse  process  of  the  sixth  cervical 
vertebra,  from  whence  its  course  is  through  the  similar  fora- 
mina of  the  other  vertebrae.  After  passing  through  the  for- 
amen of  the  transverse  process  of  the  atlas  it  passes  back- 
wark  and  inward  between  the  margin  of  the  foramen  magnum  and 
the  arch  of  the  atlas  and  behind  the  articular  surfaces,  in  close  asso- 
wation  ivith  the  occipito-atlantal  ligaments.  From  thence  it  pierces 
the  dura  mater  and  arachnoid,  dividing  to  send  a  branch  up- 
ward to  assist  in  the  formation  of  the  circle  of  Willis  and 
others  downward  to  supply  the  cord  throughout  its  whole  ex- 
tent. During  its  course  the  artery  is  subject  to  lesion  from 
various  structures.  Before  passing  into  the  foramen  in  the 
process  of  the  sixth  cervical  it  lies  between  the  longus  colli 
and  scalenus  anticus  muscles.  Chronic  contractures  of  these 
structures  may  easily  produce  disturbance  of  the  blood  flow. 
During  its  progress  through  the  cervical  foramina  it  is  sub- 
ject to  lesion  by  distorted  osseous  and  ligamentous  struc- 
tures. In  the  region  of  the  atlas  it  is  in  contact  with  the 
superior  oblique  muscle  and  as  it  passes  over  the  arch  of  the 


250  PRINCIPLES   OF  OSTEOPATHY. 

atlas  in  company  with  the  occipital  nerve  is  subject  to  pres- 
sure by  tightened  conditions  in  that  region  which  elevate  or 
otherwise  distort  the  first  cervical  or  disturb  its  relations  with 
the  occiput.  It  is  stated  by  Quain  that  in  extreme  rotation  of 
the  head  the  artery  is  put  upon  the  stretch  and  is  compressed 
on  the  side  from  which  the  head  is  turned.  Under  normal 
conditions  this  of  course  will  not  affect  the  blood  flow  for  a 
sufficient  time  to  result  in  disorder,  but  in  chronic  thickening 
of  the  structures  and  marked  displacements  it  is  not  unreas- 
onable to  assume  a  considerable  possibility  of  harm. 

Branches  from  the  vertebral  artery  pass  off  laterally  and 
constitute  the  intervertebral  system.  These  pass  into  and 
through  the  intervertebral  foramina  to  supply  the  spinal  cord 
and  its  surrounding  structures  including  the  general  spinal 
column.  Hence  thickened  ligamentous  and  muscular  con- 
ditions as  well  as  the  common  subluxations  of  the  vertebrae 
may  easily  interfere  with  the  interchange  in  this  region. 
Other  branches  pass  to  supply  the  deep  cervical  muscles  and 
other  soft  tissues  and  thus  are  subject  to  pressure  from  ab- 
normal states  of  these  structures.  The  venous  part  of  the 
intervertebral  system,  while  not  made  up  of  the  same  size  or 
number  as  the  arterial,  is  in  general  distributed  with  the  ar- 
terial and  will  be  alike  affected,  producing,  with  reference  to 
the  blood  supply  of  the  various  parts,  the  condition  opposite 
to  that  produced  by  interference  with  the  artery. 

In  general,  lesion  to  the  vertebral  system  will  affect  the 
folloAving  structures:  the  intra- cranial  structures  sup- 
plied by  the  circle  of  Willis,  and  some  parts  of  the  cerebellum 
and  medulla;  the  spinal  canal  including  the  spinal  column 
with  connecting  tissues  and  the  enclosed  nervous  structures; 
the  deep  tissues  of  the  neck  posteriorly.  The  effects  that  may 
result  from  interference  with  the  several  parts  of  this  vascu- 
lar system  are  extremely  uncertain,  numerous,  and  varied. 
Especially  is  this  true  where  the  disturbance  affects  those 
branches  which  supply  the  central  nervous  system.  For,  as  al- 
ready briefly  discussed,  the  effects  from  a  disturbed  metab- 


UBF/:PY  CF 


1     P  K  '.'  £  f  C  f  £  f  f  S  /!'  G  f  J 

CERVICAL   LESIONS  —  EFFECTS.  251 

olism  in  the  nerve  cells  within  the  cord  are  subject  to  laws 
but  few  of  which  are  known,  and  in  any  given  case  no  proph- 
ecy can  be  made  as  to  the  nature  or  even  location  of  the  effect  that 
may  result  from  an  ancemia  or  a  hypercemia  of  a  part  of  the  spinal 
cord.  With  reference  to  the  branches  distributed  to  the  mus- 
cles of  the  posterior  cervical  region  the  same  considerations 
hold,  regarding  the  application  otHarfs  explanation  of  effects 
from  contractured  muscles,  as  were  discussed  in  connection 
with  the  spine.  Here  these  muscles  by  contracture  may  cause 
a  secondary  congestion  in  the  branches  that  pass  to  the  cervi- 
cal part  of  the  spinal  cord,  since  the  intervertebral  supplyjand 
the  muscle  supply  of  blood  are  from  the  same  arterial  branches. 

A  third  system  of  vessels  likely  to  be  involved  from  cer- 
vical lesion  is  the  thyroid,  also  coming  from  the  subclavian. 
The  inferior  thyroid  branch  passes  upward  from  the  thoracic 
cavity  into  the  deep  tissues  of  the  anterior  cervical  region, 
lying  in  front  of  the  longus  colli  muscle  and  the  transverse 
processes  of  the  vertebrae,  to  be  distributed  to  the  thyroid 
gland,  trachea,  esophagus,  and  deep  muscles  of  the  antero- 
lateral  aspect  of  the  neck.  The  other  branches  from  the 
thyroid  axis  supply  various  structures  in  the  cervico-  thoracic 
region.  The  veins  associated  with  this  system  ultimately  pass 
with  the  innominate  but  those  in  connection  with  the  thyroid 
gland  are  of  special  importance.  Of  these  the  inferior  thy- 
roid are  the  most  important,  the  middle  and  superior  being 
small  and  less  subject  to  lesion.  Dr.  Still  emphasizes  the  . 
importance  of  the  inferior  thyroid  in  conditions  of  goitre,  in 
which  the  closeness  of  the  tissues  at  the  cervico  -thoracic 
junction  may  impair  the  flow  of  blood  from  the  thyroid  gland. 
These  structures  lie  in  close  relation  to  the  sterno-mastoid, 
the  sterno-hyoid,  and  sterno-thyroid  muscles  and  hence  con- 
tracture of  the  latter  may  more  or  less  seriously  obstruct  ven- 
ous drainage  of  the  parts. 

EFFECTS  ON  SPINAL  NERVES. 

Of  the  nervous  structures  that  may  be  interfered  with  by 


252  PRIHCIPLES   OF  OSTEOPATHY. 

cervical  lesions  are  the  eight  spinal  nerves,  the  fifth,  seventh, 
ninth,  tenth,  eleventh,  and  the  twelfth  cranial,  and  the  cervi- 
cal sympathetic  system,  including  the  superior,  middle,  and 
inferior  cervical  ganglia  with  their  branches  and  connecting 
cords. 

The  cervical  spinal  nerves  with  the  exception  of  the 
first  and  second  pass  from  the  spinal  cord  through  the  inter- 
vertebral  foramina  and  divide  into  anterior  and  posterior 
branches  which  supply  corresponding  portions  of  the  cervical 
tissues  with  fibres  of  a  motor  and  sensory  function.  The  first 
or  suboccipital  leaves  the  cord  over  the  posterior  arch  of  the  atlas 
in  close  relation  to  the  vertebral  artery,  and  hence,  like  the 
latter  structure,  is  subject  to  pressure  between  the  arch  and 
the  occipital  bone.  The  posterior  division  of  the  nerve  passes 
into  the  suboccipital  triangle  where  it  supplies  numerous  of 
the  adjacent  structures  lying  in  close  relation  to  the  recti  and 
obliqui  and  complexus  muscles.  Tightened  conditions  of 
these  structures  may  produce  various  disorders  of  a  sensory 
or  motor  nature  from  interference  with  the  normal  activity 
of  this  nerve  and  its  segment  of  the  spinal  cord.  The  second 
cervical  nerve  with  its  principal  branch,  the  great  occipital, 
passes  from  the  spinal  canal  between  the  posterior  arch  of  the 
atlas  and  the  lamina  of  the  axis.  It  passes  upward  across 
the  inferior  oblique  muscle  throiigh  the  complexus  and 
trapezius  to  reach  the  back  of  the  head  whose  superficial 
structures  it  supplies  over  a  considerable  area.  Occipital 
headaches  in  numerous  cases  seem  to  be  dependent  upon  a 
crowded  condition  of  this  nerve  in  its  superior  cervical  course. 
The  posterior  branches  of  the  other  cervical  nerves  are  dis- 
tributedin  association  with  the  deep  cervical  tissueswhere  they 
may  be  irritated  by  the  posterior  cervical  muscles,  or  on  the 
other  hand  cause  disturbance  of  the  latter. 

The  anterior  divisions  of  the  cervical  nerves  form  the 
cervical  plexuses.  The  upper  four  which  form  the  cervical 
plexus  proper  pass  out,  with  the  exception  of  the  first,  from 
between  the  inter-transverse  muscles^  lying  in  relation  with  the 


CERVICAL  LESIONS — EFFECTS.  253 

upper  portion  of  the  scalenus  medius ;  the  first  of  the  anterior 
branches  emerges  between  the  two  recti  muscles.  The  four 
branches  joining  in  various  ways  form  the  cervical  plexus 
which  as  a  whole  lies  upon  the  scalenus  medius  and  the  leva- 
tor  anguli  scapulae  muscles  and  beneath  the  sterno-mastoid. 
Hence  in  their  deeper  and  superficial  relations  they  are  sub- 
ject to  lesion  from  pressure  by  contraction  of  these  various 
structures.  These  nerves  carrying  sensory  and  motor  fibres 
are  distributed  to  the  skin  and  muscles  of  the  cervical  and 
cephalic  regions,  as  well  as  sending  a  few  branches  to  reach 
the  upper  thoracic  tissues  and  forming  one  nerve  of  special 
importance,  the  phrenic,  which  passes  to  the  diaphragm  and 
other  structures.  Descending  from  its  roots  of  origin  the 
latter  passes  across  the  front  of  the  scalenus  anticus  behind 
the  sterno-mastoid,  sterno- thyroid,  and  sterno-hyoid  muscles. 
In  the  cervico -thoracic  region  it  is  therefore  subject  to  lesion 
from  bony  and  muscular  conditions. 

The  lower  cervical  nerves,  by  their  anterior  branches, 
emerge  from  between  the  scaleni  muscles,  and  lying  upon 
these  form  the  brachial  plexus  which,  passing  under  the 
superficial  tissues  at  the  base  of  the  neck,  courses  over  the 
first  rib  and  underneath  the  clavicle  to  supply  the  arm, 
shoulder,  and  cervico -thoracic  regions  with  sensation  and 
motion.  Distorted  conditions  of  the  lower  cervical  in  the 
regions  of  the  roots  of  these  nerves,  muscular  contractures  in 
the  cervico-thoracic  area,  and  narrowed  costo- clavicular 
spaces  may  produce  disorder  of  one  or  more  parts  of  the 
plexus  with  a  resulting  weakness  of  the  arm. 

In  general  the  effects  of  lesions  upon  the  cervical  spinal 
nerves  are  muscular  contractures,  sensory  disorders,  and 
numerous  other  conditions  near  and  remote,  dependent  upon 
a  disturbed  activity  of  the  segments  of  the  cervical  portion 
of  the  spinal  cord.  Especially  would  this  seem  to  be  true  of 
the  upper  cervical  lesions  which,  disturbing  the  metabolism 
of  the  upper  part  of  the  cord  may  seriously  interfere  with  the 
activity  of  the  centers  in  the  medulla.  In  all  probability  ^  it  is 


254  PRINCIPLES   OF   OSTEOPATHY. 

by  Ie8sening  the  irritation  to  the  medulla-through  the  medium 
of  the  suboccipital  nerves  that  treatment  in  the  suboccipital 
region  in  numerous  cases  will  lessen  general  nervous  distress, 
vaso-motor  irregularities,  and  cardiac  disorders. 

EFFECTS  ON  CRANIAL  NERVES. 

The  fifth  cranial  nerve  being  largely  distributed  to  the 
facial  structures  and  issuing  from  the  cranium  in  regions  well 
protected  is  not  markedly  subject  to  cervical  lesion.  A  few 
branches  distributed  to  the  inferior  maxillary  articulation  and 
to  a  few  other  structures  in  the  lower  facial  region  may  be 
directly  subject  to  superior  cervical  contracture  or  inferior 
maxillary  luxation.  Through  coritractured  conditions  of  the 
facial  muscles  disordered  conditions  of  the  nerve  are  quite 
common.  Secondarily  the  nerve  may  be  involved  in  disorder 
because  of  nutritional  disturbances  of  the  Gasserian  ganglion 
or  of  its  central  origin,  and  through  its  numerous  close  con- 
nections with  the  ascending  branches  of  the  superior  cervical 
ganglion  of  the  sympathetic.  The  nerve  as  a  whole  may  be 
considered  the  most  important  of  those  associated  with  the 
head  and  face,  being  distributed  in  large  part  to  the  eye  and 
its  appurtenances,  the  ear,  the  nose,  and  the  mouth.  These 
structures  derive  their  sensory  capacities  from  the  fifth,  while 
motor  filaments  are  distributed  to  the  muscles  of  mastication. 
Neuralgias  associated  with  the  various  branches  of  the  fifth 
are  common  disorders  dependent  on  inferior  maxillary  and 
superior  cervical  lesions.  While  through  the  vaso-motor  fibres 
that  it  carries,  having  received  them  from  the  sympathetic, 
it  is  often  accountable  for  congestive  and  secretory  disturb- 
ances of  the  eye  and  other  cephalic  organs.  The  relations 
between  this  nerve  and  the  sympathetic  system  will  be  dis- 
cussed more  in  detail  in  the  section  on  the  sympathetic  nerves. 

The  seventh  or  facial  nerve  is  the  principle  motor  nerve 
to  the  face,  and  hence  lesions  affecting  it  are  in  the  nature  of 
spasms  and  paralyses  of  the  facial  muscles.  Bell's  paralysis  is 
a  typical  example  of  the  latter,  in  which  most  of  the  muscles 


CERVICAL  LESIONS — EFFECTS.  255 

of  one  side  of  the  face  are  more  or  less  completely  paralyzed. 
This  nerve  is  subject  to  lesion  at  its  exit  from  the  stylo-mastoid 
foramen  which  is  in  sufficiently  close  relation  to  the  inferior 
maxillary  structures  and  transverse  process  of  the  atlas  to  be 
affected  by  disordered  conditions  of  the  muscles  and  con- 
necting tissues  of  those  regions. 

The  glosso-pharyngeal  nerve  is  subject  to  lesion  at 
its  exitjrom  the  skull  and  during  its  course  to  its  distribution  to 
the  tongue,  pharynx,  middle  ear,  and  parotid  gland, to  which 
it  furnishes  fibres  of  various  functions.  It  is  sensory  to  most 
of  the  structures  named,  motor  to  the  stylo-pharyngeus  and 
middle  constrictor,secretor?/  and  vaso-dilator  to  the  parotid  gland. 
Passing  from  the  skull  in  company  with  the  tenth  and  eleventh 
cranials  it  courses  downward  in  front  of  the  transverse  process 
of  the  atlas,  then  deeply  passing  in  relation  to  the  styloid 
muscles  and  the  hyo-glossus.  In  these  situations  it  is  subject 
to  lesion  from  atlas  disorders  or  contractures  in  the  anterior 
upper  cervical  areas. 

The  tenth  or  vagus  is  one  of  the  most  important  of 
cranial  nerves,  from  its  wide  distribution,  its  diversity  of 
function,  and  its  relation  to  various  structural  parts  which 
may  act  as  an  irritant.  Atlas  lesions  are  often  found  to  dis- 
turb its  function.  The  nerve  passes  down  in  front  of  the 
transverse  process,  and  hence  subluxated  conditions  of  that 
structure,  either  by  direct  pressure  or  through  the  production 
of  congestion  and  thickenings  of  adjacent  and  related  tissues, 
will  more  or  less  markedly  interfere  with  its  condition.  It 
then  passes  down  the  side  of  the  neck  in  the  common  sheath 
of  the  nerve,  carotid  artery,  and  internal  jugular  vein,  under- 
neath the  anterior  border  of  the  sterno-mastoid  and  overlying 
the  deep  cervical  muscles.  In  this  region  it  is  subject  to 
osseous  subluxations  and  muscular  contractions  sufficient  to 
produce  disturbance.  In  this  region,  too,  it  may  be  reached 
more  or  less  directly  by  pressure  against  the  anterior  part  of 
the  sterno-mastoid,  or  in  the  lower  cervical  region,  reaching 
underneath  the  tissues  from  in  front  and  pressing  inward, 


256 


PRINCIPLES    OF   OSTEOPATHY. 


then  outward.  In  its  cervico-thoracic  course  it  and  its  laryngeal 
.  branches   are    subject    to 

1  ^**"^/ur  '^Ho-s^i  irritation  from  a  tightened 
\  &*\\***i*f  if  -V  ft  s  condition  of  the  inferior  cer- 
^S- -  ^*fr  /  jj^^y^^'^  vical  structures  and  from  a 

narrowed  superior  opening 
of  the  thorax.  A  very 
common  disorder,  a  light 
hacking  cough,  is  often 
/Y  f  dependent  on  such  a 

Fro.  22.— Showing  relation   between   Crowding  of  these    tissues 

tn™J.er8e  pro  a  w  h  i  c  h   keeps  up  an  i  r  r  i- 

tation  to  the  inferior  laryngeal  branches.  The  effects  which 
may  follow  f zom  lesion  acting  upon  this  nerve  by  the  cer- 
vical disorders  are  most  numerous  and  varied.  It  must 
be  borne  in  mind  that  the  vagus  is  in  reality  a  bundle 
of  nerves  and  is  associated  with  nearly  every  type  of 
function.  It  is  afferent  and  efferent,  motor,  sensory,  vaso- 
motor,  cardiac  inhibitor  and  probably  augmentor,  secretory 
and  trophic.  Any  one  or  more  of  a  large  number  of  struc- 
tures may  suffer  from  its  disturbance.  As  suggesting  its  im- 
portance in  this  connection  may  be  quoted  a  summary  of  its 
functions  and  distribution,  from  Quain  :  ''The  pneumogastric 
nerve  conveys  motor  fibres  to  the  voluntary  muscles  of  the 
soft  palate  (with  the  exception  of  the  tensor  palati),  pharynx, 
and  larynx,  these  being  in  part  at  least  derived  originally 
from  the  spinal  accessory;  to  the  unstriped  muscle  of  the  ali- 
mentary canal — esophagus,  stomach  and  intestine  (with  the 
exception  of  the  rectum),  and  of  the  air  passages — trachea, 
bronchi,  and  their  divisions  in  the  lungs.  Sensory  fibres  are 
furnished  to  the  pharynx,  esophagus  and  stomach,  to  the 
larynx,  trachea  and  bronchial  ramifications,  as  well  as  to  the 
dura  mater,  the  external  ear  and  the  pericardium.  The  vagi 
also  supply  nerves  to  the  heart,  both  efferent  (inhibitory — 
also  received  from  the  spinal  accessory),  and  afferent  (de- 
pressor), and  possibly  inhibitory  dilator  fibres  to  the  vessels 


CERVICAL  LESIONS— EFFECTS.  257 

of  the  intestine.  Lastly,  pneumogastric  fibres  pass,  either 
directly  or  through  the  solar  plexus  and  its  offsets,  to  the 
liver,  pancreas,  spleen,  kidneys  and  suprarenal  bodies.  Each 
pneumogastric  nerve  is  connected  with  the  following  cranial 
nerves — the  spinal  accessory,  glosso-pharyngeal,  facial,  and 
hypoglossal;  also  with  some  spinal  nerves;  and  with  the 
sympathetic  in  the  neck,  thorax  and  abdomen." 

In  accordance  with  this  distribution  and  functioning  there 
are  found  disorders  of  the  respiratory  tract  ^ — sensory  irrita- 
tions with  cough,  excessive  mucous  secretion,  muscle  con- 
strictions in  the  bronchial  walls  as  in  asthma,  respiratory 
arrhythmias  dependent  on  the  fact  that  afferent  impulses  by 
way  of  vagus  fibres  aid  in  regulation  of  the  respiratory  cen- 
ter in  the  medulla;  of  the  alimentary  tract — sensory  disorders, 
undue  vomiting  tendencies  either  an  excess  or  a  deficiency, 
secretory  disturbances  of  the  glands  associated  with  the  tract, 
disturbance  of  motion  by  virtue  of  its  motor  fibres  to  the  vis- 
ceral walls  producing  constipation  or  diarrhoea  (undoubtedly 
rare), constriction  or  dilatation  of  the  stomach;  of  the  vascular 
system  through  interference  with  the  inhibitor  function  of  the 
nerve  on  the  heart  muscle,  and  vaso- motor  function  to  the 
coronary  arteries,  the  impairment  of  afferent  impulses  by  way 
of  the  depressor  nerve  to  the  vaso -motor  center  in  the  me- 
dulla, and  dilator  fibres  to  vessels  of  the  alimentary  wall ;  of 
other  systems  of  nerves  with  which  the  vagus  is  connected,  in- 
cluding the  centers  in  the  central  nervous  system  upon  which 
the  nerve  undoubtedly  exercises  a  greater  or  less  controlling 
influence. 

The  eleventh  or  spinal  accessory  is  another  nerve 
which  may  be  subject  to  the  same  lesions  in  the  superior  cer- 
vical region  as  the  ninth  and  tenth.  This  nerve  after 
passing  from  the  foramen  with  the  others  named,  immediate- 
ly perforates  the  sterno-mastoid  and  passes  across  the  pos- 
terior triangle  of  the  neck  to  be  further  distributed  to  that 
muscle  and  the  trapezius.  Tightened  conditions  of  those  mus- 
cles may  affect  it  and  possibly  reflexly  affect  others.  This 


258  PRINCIPLES    OF    OSTEOPATHY. 

nerve  is  in  large  part  a  spinal  nerve  since  it  arises  largely  from 
offshoots  from  the  upper  five  or  six  segments  of  the  spinal 
cord  to  pass  upward  through  the  foramen  magnum  and  be 
distributed  with  its  own  peripheral  fibres  and  with  those  which 
pass  to  the  pneumogastric.  It  is  believed  to  carry  from  this 
region  of  the  cord  fibres  which  correspond  to  those  which 
make  up  the  white  rami  of  the  sympathetic  in  other  parts  of 
the  cord. 

The  twelfth  or  hypoglossal  issues  from  the  anterior  condy- 
lar  foramen,  and  from  this  point  is  subject  to  lesion  from 
tightness  in  the  region  as  it  passes  to  supply  the  tissues  of  the 
tongue  and  of  the  hyoid  structures,  as  well  as  in  the  region  in 
which  it  gives  branches  to  join  with  those  of  the  sympathetic 
and  upper  spinal  nerves.  Disorders  directly  traceable  to 
lesion  of  this  nerve  are  apparently  not  at  all  numerous  or  im- 
portant. 

EFFECTS  ON  THE  CERVICAL  SYMPATHETIC. 

The  cervical  part  of  the  sympathetic  system  consists  of 
the  three  cervical  ganglia  and  their  connecting  cords, 
branches  to  the  spinal  nerves,  ascending  fibres  from  the  su- 
perior ganglion,  connecting  fibres  to  the  thoracic  ganglia, 
and  rami  efferentes  that  pass  to  aid  in  formation  of  the  car- 
diac, esophageal,  laryngeal,  pharyngeal,  and  minor  plexuses 
in  the  cervical  areas. 

The  superior  cervical  ganglion  is  the  largest  of  all 
the  cord  ganglia  being  from  three  quarters  to  one  inch  in 
length  and  an  eighth  to  a  fourth  of  an  inch  in  diameter.  It  is 
presumably  a  fusion  of  several  ganglia,often  being  constrict- 
ed and  usually  connected  with  the  upper  four  spinal  nerves.  It 
lies  in  front  of  the  transverse  processes  of  the  second  and 
third  cervical  vertebrae  upon  the  rectus  anticus  major  •  muscle 
in  a  network  of  connecting  structures  behind  the  internal 
carotid  artery.  Its  ascending  branches  pass  to  supply  the  in- 
ternal carotid  artery,  forming  in  the  cranium  the  carotid 
plexus,  and  with  other  branches,  the  cavernous  plexus. 


CERVICAL   LESIONS — EFFECTS. 


259 


From  these  plexuses  the  fo  1 1  owing  structures 

*\  o  a*  e  i  do- 


To  "Mj^  (SWvuaU 


Fig.  23.— Distribution  of  Cervical  Sympathetic. 


are  supplied  : 
filaments    to 
the    Gasser- 
ian  ganglion 
of  the    fifth 
cranial;     to 
the  third, 
fourth,  fifth, 
and  sixth 
c  r  an  ial  fi- 
bres; by  the 
large  'deep 
pe  t  ro  s  sal 
nerve  to  aid 
in  formation 
of    the  Vid- 
ian  ;  to  the 
tympanic 
plexus;  to 
the   ciliary 
g  a  n  gl  i  on 
from  whence 
fibres  pass 
to   the    eye; 
a  n  d  t  o   the 
pituitary 
body.  Later- 
al  branches  of 
the  ganglion 
are  given  off 
t  h  a  t  aid  in 
the  forma- 
tion  of  t  h  e 
phary  n  g  e  a  I 
and  laryngeal 
plexuses, 


260  PRINCIPLES   OF   OSTEOPATHY. 

from  which  fibres  pass  to  the  mucous  membrane  and  other  tis- 
sues and  make  connection  with  the  superior  and  external  laryn- 
geal  nerves.  A  few  filaments  may  pass  to  aid  in  formation 
of  the  esophageal  plexus  distributed  to  the  mucous  lining  of 
that  canal.  Other  lateral  branches  are  given  off  which  unite 
to  form  the  upper  cardiac  nerve  of  the  sympathetic  which 
passes  down  lying  in  front  Of  the  longus  colli  muscle,  from 
whence  it  passes  into  the  thorax  to  join  the  cardiac  plexus, 
giving  off  in  its  course  branches  which  connect  with  the 
other  cardiac  nerves  and  the  pneumogastric  with  its  inferior 
laryngeal  branch,  and  giving  off  a  filament  to  the  inferior 
thyroid  artery  to  be  distributed  to  the  thyroid  gland.'  Other 
lateral  branches  pass  to  the  external  carotid  artery  which  are 
distributed  with  its  branches  to  the  submaxillary,  otic,  and 
geniculate  ganglia, 

The  middle  cervical  ganglion  is  occasionally  absent 
and  when  present  is  the  smallest  of  the  cervical  ganglia.  It 
lies  upon  the  tissues  in  front  of  the  transverse  process  of 
the  sixth  cervical  vertebra  and  is  connected  with  they?/M  and 
sixth  spinal  nerves.  Its  lateral  branches  pass  to  the  inferior 
thyroid  artery  to  supply  the  thyroid  gland,  and  make  connec- 
tion with  branches  of  the  pneumogastric  and  fibres  from^he  su- 
perior cervical  ganglia.  Other  fibres  form  the  middle  cardiac 
nerve. 

The  inferior  cervical  ganglion  lying  upon  the  con- 
nective tissue  associated  with  the  junction  of  the  first  rib  with 
the  body  of  the  vertebra,  is  often  united  with  the  first  thoracic 
ganglion.  Fibres  from  this  ganglion  form  the  rami  which 
connect  with  the  two  lower  cervical  nerves.  Lateral  branches 
form  the  lower  cardiac  nerve  which  is  usually  connected  with 
the  middle.  Others  in  company  with  similar  branches  from 
the  first  thoracic  ganglion  pass  to  the  vertebral  artery  and  form 
upon  it  the  vertebral  plexus  from  which  fibres  are  distributed 
to  the  various  spinal  nerves  and  to  the  terminal  branches  of 
the  artery.  Other  fibres  form  a  loop  (the  annulus  of  Vieus- 
sens)  around  the  subclavian  artery  from  which  that  artery  is 


CERVICAL  LESIONS — EFFECTS.  261 

supplied  with  a  plexua.  From  this  latter  plexus  fibres  are 
given  off  which  form  a  plexus  upon  the  internal  mammary 
artery.  Communications  with  the  phrenic  nerve  are  made 
from  this  plexus  and  from  branches  direct  from  the  lower 
cervical  ganglia. 

The  connection  between  the  cervical  sympathetic  and 
the  spinal  nerves  is  somewhat  different  from  that  in  the 
thoracic  region  in  that  there  are  no  tvhite  communicating  rami. 
The  grey  rami  are,  however,  equally  developed.  Fibres  aris- 
ing in  the  cervical  portion  of  the  cord  and  similar  in  all  struc- 
tural respects  to  the  white  fibres  of  the  thoracic  rami,  pass 
out  with  the  roots  forming  the  spinal  portion  of  the  spinal  ac- 
cessory nerve,  and  are  distributed  with  branches  of  that 
nerve  and  with  the  pneumogastric  and  parts  of  the  sympa- 
thetic with  which  the  accessory  is  connected. 

Thus  hurriedly  has  been  given  a  description  of  the  cervical 
sympathetic  which  throws  some  light  upon  the  numerous  dis- 
ordered conditions  that  result  from  lesions  to  the  sympathetic 
in  the  cervical  region.  It  remains  to  take  up  more  in  detail 
these  various  disorders. 

The  eye  and  its  appurtenances  are  often  involved  in  dis- 
order from  cervical '  lesions.  Pupillo-dilator  fibres  ascend 
through  the  cervical  sympathetic  reaching  the  Gasserian 
ganglion  and  passing  to  the  eyeball  through  branches  of  the 
fifth  cranial.  Occasionally  disorders  of  the  iris  muscle  re- 
sults from  lesion  affecting  these.  According  to  many  investi- 
gators constrictor  fibres  for  the  pupil  arise  in  the  superior  cer- 
vical and  pass  through  a  similar  course.  Motar  fibres  to  the 
involuntary  muscle  of  the  orbit  and  eyelids  pass  in  a  similar 
manner  through  the  cervical  sympathetic.  Secretory  fibres 
pass  to  the  eye  by  way  of  the  branches  from  the  fifth  nerve, 
which  may  be  partially  under  control  of  filaments  from  the 
sympathetic.  Through  the  connection  between 'the  sympa- 
thetic and  the  third,  fourth,  and  sixth  cranial  nerves,  dis- 
orders of  the  muscles  of  the  eyeball  such  as  strabismus  may 
result.  But  more  important  than  any  of  these  are  the  inter- 


262  PRINCIPLES   OF   OSTEOPATHY. 

ferences  with  the  sympathetic  filaments  that  are  concerned 
with  the  -vase-motor  conditions  of  the  eyeball  and  of  the  sur- 
rounding structures.  P'or  it  is  true  of  the  eye  as  of  other  organs 
that  most  of  its  disorders  are  associated  with  a  disturbance 
of  its  supply  of  blood.  The  numerous  branches  from  the 
carotid  and  cavernous  plexuses  are  concerned  with  regulat- 
ing the  supply. 

The  ear  may  suffer  from  an  involvement  of  the  cervical 
sympathetic.  The  tympanic  plexus  which  is  distributed  to  the 
inner  surface  of  the  middle  ear  is  made  up  quite  largely  from 
the  filaments  derived  from  the  intra- cranial  branches  of  the 
sympathetic.  The  functions  of  these  are  not  definitely  ascer- 
tained but  presumably  are  concerned  in  secretory,  vaso-motor^ 
and  in  general  trophic  activities  of  the  mucous  surfaces  which 
line  the  tympanic  cavity,  including  the  inner  surface  of  the 
tympanic  membrane  and  the  mastoid  cells.  Through  the 
regulation  of  the  size  of  the  carotid  arterioles,  the  sympa- 
thetic probably  exercises  its  greatest  influence  upon  the  func- 
tion of  the  ear.  Disorder  affecting  the  carotid  plexus,  then, 
may  produce  serious  disorder  of  that  organ. 

The  faucial  and  nasal  mucous  membranes  will  be  af- 
fected through  interference  with  the  sympathetic  fibres  that 
pass  with  the  vessels  which  supply  those  regions.  In  addition 
fibres  are  given  to  \h.s  fifth  cranial  which  is  the  principal  nerve 
to  the  mucous  lining.  These  fibres  exercise  either  directly  or 
indirectly  &  secretory  and  trophic  influence  upon  the  membrane. 
Most  catarrhal  conditions  are  dependent  on  lesions  in  the 
upper  cervical  regions  which  in  one  or  more  of  these  several 
ways  disorder  the  nutritive  condition  of  the  upper  respiratory 
tract. 

The  cervical  parts  of  the  respiratory  and  alimentary 
tracts  are  commonly  involved  in  disorder  through  the  irrita- 
tion to  the  branches  that  help  form  the  plexuses  distributed 
to  the  walls  of  those  channels. 

The  heart  is  likely  to  suffer  from  contractured  or  other 
lesion  conditions  of  the  cervical  region  although  this  is  a 


CERVICAL   LESIONS — EFFECTS.  263 

much  less  common  region  for  heart  lesion   than    that  lower 
down  the  spine.  Through  irritations  associated  with  the  cervi- 
cal ganglia  or  the  fibres  forming  the  cardiac  sympathetic, some 
of  which  may  arise  in  the  ganglia,  disturbed  conditions  of  the 
heart  action  may  occur.     These  fibres  are  largely  though  not 
entirely  accelerator  in  function,  i.   e.,  by  their   influence  the 
heart  muscle  is  kept  in  a  condition  of  normal  tone,   irritabil- 
ity, and  conductivity.     Any  or  all  of  these   factors   may  be 
decreased  or  increased   through  the  interference  with  the 
fibres.     Some  evidence  has  been   brought  forward   showing 
an  inhibitory  function  associated  with  the  sympathetic  fibres. 
If  such  exists  it  ia  undoubtedly   minor  in   importance.    Vaso- 
motor  fibres  are  believed  by  some  authorities  to  pass  also    by 
these   nerves  to   be   ultimately  distributed  to  the  coronary 
arteries.     Hence  disturbances  of  the  nutrition    of   the  heart 
will  result.     It  has  been  suggested  that  angina  pectoris  is  due 
to  the  temporary  spasmodic  constriction  of  the  muscle  fibres 
in  the  coronary  system;  and  in  numerous   post  mortem   ex- 
aminations of  individuals  afflicted   with  that   disease   it  has 
been  found  that  the   coronary  arteries   were    more   or  less 
thickened  and  sclerosed.     Pressure  exerted  downward   upon 
the  region  of  the  annulus  of  Vieussens  has  been  suggested  as 
a  treatment  to  inhibit  an  over-active  heart.    The  treatment  is 
unsatisfactory  because  of  difficulty  in  reaching  the   part,    an 
uncertainty  in  its  effect,  with  a  greater  probability  of  stimu- 
lation than  of  inhibition,  and  hence  personally  the  author   is 
opposed  to  the  treatment. 

Through  the  branches  that  pass  to  the  thyroid  gland 
from  the  several  ganglia  that  organ  may  suffer.  A  very 
common  lesion  associated  with  goitre  is  a  "break"  in  the 
cervico -thoracic  spine.  This  will  undoubtedly  produce  dis- 
turbance of  the  vascular  and  trophic  conditions  of  the  organ 
and  various  forms  of  disorder  may  arise. 

From  the  inferior  cervical  ganglion  the  branches  that 
form  the  vertebral,  mammary,  and  subclavian  plexuses 
arise  and  may  after  or  before  their  interlacement  be  subject 


264  PRINCIPLES   OF   OSTEOPATHY. 

to  disorder  from  lesion.  Hence  any  or  all  of  the  structures 
which  are  supplied  by  these  vessels  may  be  made  to  suffer, 
i.  e. ,  the  brain  and  cord,  the  arm  and  shoulder,  and  the 
mammary  gland  and  associated  tissues. 

Finally  emphasis  is  to  be  laid  upon  the  effects  that  may 
result  from  the  interference  with  the  fibres  that  pass  from  the 
ganglia  as  grey  rami  to  be  distributed  to  the  general  spinal 
structures  in  a  manner  similar  to  that  dessribed  in  the  section 
discussing  the  general  distribution  of  the  sympathetic  system 
(See  Fig.  13).  Thus  through  the  lesions  affecting  those  fibres 
the  nutrition  of  the  cord  itself  will  be  involved  and  therefore 
practically  all  of  the  structures  already  mentioned  may  be 
disordered  because  of  the  changed  nature  or  number  of  the 
outgoing  impulses  from  the  various  segments  and  through 
the  various  pathways.  Of  these  latter  some  are  by  way  of 
fibres  passing  up  to  the  medulla  and  other  parts  of  the  brain 
where  they  may  produce  brain  disorders  proper,  or  interfere 
with  the  impulses  that  pass  out  by  way  of  the  cranial  nerves. 
Others  pass  out  with  the  spinal  roots  of  the  spinal  accessory  and 
are  distributed  with  that  nerve.  Others  pass  down  the  cord  and 
may  affect  almost  any  structure  connected  with  the  lower 
segments  through  the  mediation  of  the  law  of  radiation  of 
impulses.  Still  others  pass  down  to  issue  by  way  of  the 
white  rami  in  the  thoracic  portion,  thence  in  part  to  pass  up- 
ward into  the  cervical  cord  from  whence  they  are  distributed 
in  the  numerous  ways  already  described.  While  still  others 
may  issue  from  the  cervical  cord  through  the  grey  rami  by  way 
of  white  fibres  which  are  present  in  small  number.  This  disturb- 
ance of  the  cord  of  course  need  not  be  dependent  upon  the 
irritation  to  the  grey  fibres  that  pass  back  to  the  spinal  canal 
from  the  sympathetic  ganglia.  In  large  part  it  will  result  as 
has  been  before  suggested,  from  posterior  muscle  contracture  or 
other  lesion  which  produces  an  excess  of  afferent  impulses  by 
way  of  the  spinal  sensory  nerves. 

Notice  should  further  be  taken  of  the  fact  that  with   all 
the  spinal  nerves,  both  anterior  and  posterior  branches, 


CERVICAL  LESIONS — EFFECTS.  265 

there  pass,  through  connection  by  grey  rami,  sympathetic 
fibres  received  from  cells  in  the  three  cervical  ganglia.  These 
fibres  are  concerned  with  vaso-motion  to  the  vessels  of 
the  muscles  and  superficial  tissues;  pilo-motor  influences 
to  the  involuntary  muscle  in  the  skin ;  and  secretory  fibres 
to  the  sweat  glands.  Hence  lesion  to  the  sympathetic 
will  be  accountable  for  numerous  skin  and  superficial  muscle 
disorder  in  the  facial,  occipital,  cervical,  and  upper  thoracic 
areas.  Pimples  of  various  kinds,  eruptions,  dry  and  scaly 
skin  conditions,  excessive  or  deficient  sweat  or  sebaceous 
secretion  and  numerous  other  states  of  these  areas  are  com- 
mon and  are  presumably  related  to  the  cervical  lesions  that 
are  found. 


18 


266  PRINCIPLES   OF   OSTEOPATHY. 


CHAPTER  XIIL 


THORACIC  AND  LUMBAR  LESIONS— SPINAL. 
THORACIC  LESIONS— GENERAL. 

Thoracic  lesions  involving  the  spine  are  among  the  more 
common  and  important,  for  it  is  in  this  part  of  the  cord  that 
most  of  the  efferent  impulses  for  sympathetic  life  pass  from 
the  spinal  cord  through  the  mediation  of  the  white  rami.  A 
few  of  the  characteristic  lesions  will  be  described  and  later 
their  treatment  and  effects  discussed. 

In  making  the  examination  do  so  first  with  the  patient 
in  the  sitting  posture.  For  purposes  of  inspection  the  skin 
should  be  bared.  Note  the  position  in  which  the  spine  is 
held.  There  should  be  when  the  individual  sits  in  a  natural 
and  easy  position  a  posterior  curve  beginning  with  the  second 
and  extending  to  the  twelfth  with  the  most  prominent  part  of 
the  convexity  at  the  seventh  or  eighth  spine.  In  many  cases 
there  will  be  either  an  exaggeration  of  this  curve  or  a  partial 
or  even  complete  obliteration  of  it.  Before  determining  that 
it  is  an  abnormal  condition  the  patient  should  be  made  to  vary 
the  curve  by  sitting  over-erect  and  by  "sinking"  the  spine 
upon  itself  to  throw  it  as  posterior  as  is  possible.  By  obser- 
vation in  the  several  conditions  there  will  be  less  possibility 
of  error.  A  very  common  condition  of  the  upper  thoracic 
spine  is  the  flat  inter-scapular  region.  As  a  result  of 
this  flattening  there  will  be  presented  a  more  or  less  typical 
straight  condition  of  the  spine  as'a  whole,  owing  to  a  secondary 
and  compensatory  straightening  in  the  lumbar  region.  Fur- 
ther the  transverse  processes  should  be  noted,  since  a  spine 
will  appear  straighter,  owing  to  the  greater  obliquity  of  the 
spinous  processes  in  the  thoracic  region  than  in  the  other 
parts,  if  examined  by  reference  to  its  spinous  than  if  examin- 


THORACIC   AND   LUMBAR   LESIONS— SPINAL.  267 

ed  by  its  transverse  processes.  These  transverse  processes 
will  be  difficult  to  detect  by  the  average  student,  since  the 
more  or  less  marked  protuberance  and  the  depression  external 
to  it,  as  seen  in  the  skeleton,  will  be  quite  completely  covered 
by  Jigamentous  and  musular  tissues  in  the  average  living  sub- 
ject. They  can  usually  be  detected  if  care  be  exercised, 
about  one  and  one-half  inches  to  the  side  of  the  spinous  process. 
Remember  further  that  the  process  of  the  typical  thoracic 
vertebra  will  be  on  a  line,  not  with  its  own  transverse  pro- 
cesses but  with  those  of  the  vertebra  next  below  or  in  some  cases 
the  second  one  below.  A  faily  good  rule  to  remember  which 
must  not  be  applied  too  vigorously  is  this :  if  on  bending  the 
head  well  forward  the  spinous  processes  of  the  thoracic  ver- 
tebra below  the  second  can  easily  be  seen,  the  flattening  is 
not  very  serious.  If  they  are  not  drawn  out  sufficiently  to  be 
noticed  on  inspection  it  is  fairly  good  evidence  that  there  is  an 
abnormal  flattening.  It  will  be  noted  further  that  in  such  a  le- 
sion the  antero-posterior  diameter  of  the  upper  and  perhaps  lower 
part  of  the  chest  will  be  lessened.  This  can  be  best  noted  by 
applying  a  hand  on  either  aspect  and  then  noting  the  dis- 
tance between  them.  Aid  will  be  further  given  if  the  patient 
is  asked  to  respire  deeply,  noticing  the  amount  of  expansion 
possible,  and  the  freedom  of  movement  of  the  upper  chest.  In 
many  cases  but  by  no  means  all,  with  the  flat  thoracic  state 
will  be  associated  a  general  thickening  of  the  deep  tissue  so 
that  undue  rigidity  may  be  manifest.  In  long  standing  cases 
of  this  kind  there  may  be  little  or  no  muscle  contracture  appar- 
ent but  in  many  if  care  is  taken  in  palpation,  various  areas 
will  be  detected  where  not  only  muscle  thickening  will  be 
felt  but  also  tenderness  over  certain  areas  will  be  experienced 
by  the  patient.  Especially  will  the  upper  part  of  the  thoracic 
spine  be  often  involved  in  muscular  disorder.  In  the  writer's 
personal  experience  very  few  flat  thoracic  regions  are  found 
unassociated  with  the  contractured  state  of  the  rhomboids 
and  deeper  muscles  on  either  side  of  the  third  thoracic  ver- 
tebrae. 


268  PRINCIPLES   OF   OSTEOPATHY. 

Difficult  as  it  may  be  to  determine  whether  the  flatness  is 
normal  or  otherwise,  it  seems  to  the  average  beginner  to  be 
still  more  difficult  to  overcome  the  condition  when  once 
diagnosed.  This  arises  partly  from  the  fact  that  in  many  cases 
the  condition  is  normal  and  hence  should  not  be  treated.  But  it 
is  also  true  that  the  spine  distorted  in  an  an tero-  posterior 
direction  is,  other  things  being  equal,  more  difficult  to  over- 
come than  a  lateral  displacement,  and  especially  is  this  true 
of  the  upper  thoracic.  In  a  few  cases  an  ideal  condition  can- 
not be  brought  about  but  in  most  a  sufficient  return  toward 
normal  can  be  effected  to  prevent  further  serious  disorder 
from  the  lesion.  The  methods  for  reducing  the  condition  are 
numerous  but  only  a  few  will  be  indicated.  Note  that  any 
method  which  produces  a  convexity  posteriorly  will  tend  to  force 
the  part  back  but  the  method  unassisted  will  avail  little. 
Hence  to  make  the  force  acting  in  the  posterior  direction  ef- 
fective, a  movement  laterally  or  in  a  rotary  manner  will  give 
opportunity.  One  method  consists  in  strongly  bending  the 
head  forward  thus  putting  tension  on  the  ligamentum  nuchae 
which  is  continuous  with  the  supra-spinous  ligaments.  Note 
that  the  direction  of  the  spinous  process  of  the  thoracic  ver- 
tebra is  backward  and  markedly  downward.  Hence  the 
force  of  the  upward  pull  will  have  a  powerful  leverage  in  pro- 
ducing movement  at  the  part.  Then  while  one  hand  is  direct- 
ing this  movement  the  other  is  used  to  manipulate  the  verte- 
bra from  side  to  side.  At  the  same  time  the  head  may  be 
rotated  to  the  side,  which  will  give  a  lateral  tendency  to  the 
force.  This  movement  is  most  satisfactorily  executed  while 
the  patient  is  on  a  low  stool  with  the  physician  standing  at 
the  side.  In  another  method,  withithe  patient  on  the  stool,  the 
physician  may  stand  in  front  with  the  toe  of  his  shoe  on  the 
stool  and  his  knee  against  the  upper  sternum,  separated  from 
it  by  sufficient  padding  to  diffuse  the  pressure  and  prevent 
depression  of  the  ribs.  Then  bending  the  head  forward  he 
he  reaches  over  on  either  side  of  the  spine  and  while  slight 
pressure  is  exerted  laterally  so  as  to  spring  the  ribs  the  ver- 


THORACIC   AND   LUMBAR  LESIONS— SPINAL.  269 

tebrse  may  be  rotated  from  side  to  side.  This  treatment  is  to 
be  used  with  utmost  caution  and  in  any  case  where  there  is  dis- 
order or  weakness  in  the  upper  ribs  or  marked  disease  in  the 
chest  structures  much  pressure  with  the  knee  is  contra-indi- 
cated. The  advantage  of  this  movement  lies  in  the  fact  that 
direct  backward  pressure  upon  the  anterior  vertebrae  may  be 
exerted  through  the  mediation  of  the  ribs.  Another  method 
consists  in  making  use  of  the  scapular  muscles  which  attach 
to  the  vertebrae.  The  patient  lies  on  the  side,  the  arm  is 
drawn  strongly  down  and  across  the  chest.  This  of  itself  will 
tend  to  draw  the  vertebrae  somewhat  back  and  if  assisted  by 
the  other  hand  in  working  the  spinous  processes  from  side  to 
side  the  result  will  be  quite  satisfactory.  In  all  such  condi- 
tions the  physician  must  rely  quite  largely  upon  the  lateral 
movements  of  the  individual  vertebrae  to  assist  the  organism 
in  making  the  adjustment. 

Another  common  condition  associated  with  the  thoracic 
spine  is  a  lateral  swerve.  In  many  cases  this  will  be  on 
the  side  of  greatest  muscular  activity  and  hence  perhaps 
be  partly  a  normal  condition.  In  this  lesion  the  more  promi- 
nent angles  of  the  ribs  on  the  convex  side  will  be  the  most 
striking  feature  in  the  examination.  Along  with  this  there 
will  be  a  greater  noticeability  of  the  transverse  processes  on 
the  convex  and  an  obscured  condition  on  the  other.  The 
treatment  will  consist  in  exaggeration  of  the  lesion  by  strong 
forcing  of  the  spine  to  the  convexity,  then  by  exerting  pres- 
sure upon  that  side,  with  rotation,  the  part  is  forced  in  the 
opposite  direction.  This  treatment  may  be  made  with  the 
patient  in  the  sitting  posture  or  lying  upon  the  side.  In  most 
curvature  conditions  it  is  more  satisfactory  to  exert  pressure 
upon  the  transverse  processes  of  the  vertebra  and  angles  and 
sides  of  the  ribs  as  well  as  upon  the  spinous  processes,  since, 
because  of  the  rotation  of  the  vertebrae  which  has  also  occur- 
ed,  the  simple  pressure  on  the  spinous  process  may  tend  to 
produce  a  still  greater  rotation  in  the  direction  toward  which 
it  is  already  displaced. 


270  PRINCIPLES   OF  OSTEOPATHY. 

In  case  of  thickened  ligaments  acting  as  lesions 
greater  or  less  difficulty  is  encountered  in  overcoming  the  dis- 
ordered structure.  It  must  be  remembered  that  the  thoracic 
part  of  the  spine  is  the  least  movable  owing  to  the  attachment 
of  the  vertebrae  to  the  ribs  forming  a  continuous  wall  which 
gives  the  chest  the  mechanical  form  of  a  cylinder — a  form 
presenting  greater  resistance  to  distortion  and  permitting  of 
only  a  slight  extent  of  movement.  When,  therefore,  the 
already  close  articulations  have  been  supplemented  by  a 
thickening  of  their  connecting  structures  by  a  previous  long 
continued  state  of  congestion  or  inflammation,  there  will  b.e 
a  marked  resistance  to  the  production  of  any  movement  be- 
tween the  adjacent  vertebrae.  In  overcoming  a  tightened 
condition  of  any  part  of  the  spine  diagnosis  must  be  made  be- 
tween the  conditions  due  to  simple  muscle  contracture  and 
those  associated  with  definite  and  substantial  change  in  the 
ligamentous  and  other'articulating  tissues.  In  most  cases  the 
distinction  will  not  be  very  difficult  owing  to  the  fact  that  the 
rigidity  dependent  upon  muscle  contracture  will  vary  from 
time  to  time  and  can  temporarily  be  overcome  by  methods 
calculated  to  relax  the  muscles.  Further,  simple  contractur- 
ed  conditions  are  usually  of  recent  production  while  the 
thickened  ligament  condition  is  one  dependent  upon  irritation 
continued  through  a  long  period  of  time.  The  two  conditions 
may  both  be  present  in  which  the  diagnosis  will  be  more  or 
less  difficult.  Again,  the  ligamentous  condition  may  follow 
the  muscular  disorder  since  both  conditions  are  dependent 
upon  some  kind  of  spinal  irritation.  As  a  matter  of  actual  ob- 
servation it  would  seem  that  by  the  time  the  ligamentous 
rigidity  has  become  established  the  muscular  contracture  will 
have  to  a  greater  or  less  extent  disappeared.  In  overcoming 
the  rigidity  due  to  muscle  contracture  it  is  only  necessary  to 
bear  in  mind  the  methods  of  reducing  contractures  which 
have  been  referred  to  in  a  previous  chapter.  Various  rota- 
tions of  the  spine  in  the  region  of  innervation  of  the  muscles 
involved  will  serve  to  open  up  the  deeper  tissues  and  allow  of 


THORACIC   AND   LUMBAR  LESIONS — SPINAL.  271 

greater  freedom  for  vascular  and  nervous  interchange.  "With 
the  patient  on  the  ventral  aspect  or  on  the  side,  direct  pres- 
sure may  be  applied  to  the  spinal  muscles  for  temporary  re- 
laxation. Usually  the  tissues  are  manipulated  by  the  flat  of 
the  hand  and  not  the  tips  of  the  fingers.  If  the  latter  are  used 
irritation  may  result  through  excessive  pressure  over  a  small 
area.  By  the  process  of  quietly  applied  but  deep  pressure 
with  a  very  slight  movement  of  the  tissues  underneath  the 
fingers,  and  by  torsion  of  the  spine  and  other  methods  de- 
signed to  separate  and  approximate  the  origins  and  insertions, 
the  muscle  tissues  will  usually  yield  without  any  great  diffi- 
culty. It  is  not  to  be  expected  that  these  temporary  relaxa- 
tions will  result  in  a  cure,  for  in  numerous  cases  thecontrac- 
ture  is  but  a  condition  dependent  upon  some  further  cause, 
and  until  the  latter  be  determined  and  removed  little  can  be 
expected  in  the  way  of  a  permanent  cure.  Where  the  rigidity 
is  due  to  the  thickened  ligaments  the  quiet  pressure  treat- 
ment of  the  muscle  is  of  little  avail.  This  is  a  condition  which 
must  be  more  or  less  forcibly  broken  up  and  absorbed  and 
hence  rather  vigorous  methods  must  be  employed.  Theoretic- 
ally the  various  "breaking  up"  treatments  which  are  in  com- 
mon use  might  seem  to  be  illogical  in  their  application.  For 
if  the  congestion  and  the  later  overgrowth  and  contraction 
were  due  in  the  first  place  to  irritation  it  would  seem  that 
those  treatments  that  tend  to  stretch  the  ligamentous  and 
other  connective  tissues  would  result  in  still  further  irritation 
and  hence  further  congestion  and  overgrowth.  But  from 
actual  observation  of  cases  it  seems  that  the  fear  of  further 
thickening  is  not  well  grounded  and  that  the  good  resulting 
from  the  treatment  is  far  in  excess  of  any  noticeable  harm 
that  may  be  possible.  The  treatment  is  largely  the  same  in 
principle  as  that  employed  in  the  preliminary  treatment  in 
case  of  a  long  standing  dislocation  of  the  hip  where  the  mus- 
cles and  other  structures  have  become  structurally  shortened. 
In  such  cases  rotation  of  the  limb  and  other  manipulations 
are  employed  in  order  to  lengthen  these  tissues  by  stretching 


272  PRINCIPLES   OF   OSTEOPATHY. 

processes  sufficient  to  permit  of  the  reduction  of  the  dislo- 
cation. In  applying  the  various  "breaking-up"  treatments  it 
is  very  essential  that  the  physician  shall  know  the  amount  of 
pressure  he  is  exerting  and  the  efficiency  of  his  leverages.  Other- 
wise he  is  likely  to  produce  rupture  of  the  connecting  tissues 
rather  than  a  simple  yielding  of  them.  Especially  is  this  true 
with  reference  to  the  more  anterior  ligaments,  i.e.,  those 
associated  with  the  bodies  of  the  vertebrae.  If  an  examination 
is  made  of  the  skeleton  it  will  be  seen  that  the  spine,  especial- 
ly throughout  its  thoracic  and  lumbar  portions,  is  not  so  ar- 
ticulated as  to  permit  of  appreciable  anterior  convexity.  The 
structural  conditions  are  such  as  to  allow  of  a  posterior  con- 
vexity, lateral  inclinations,  and  somewhat  of  torsion  move- 
ments, but  inappreciably  a  direct  anterior  convexity.  Hence 
any  forcible  attempt  to  bend  the  spine  in  this  direction  is  to  be  con- 
demned. There  is  a  method  of  treatment  designed  to  stretch 
and  separate  the  more  anterior  structures  which  is  in  common 
use,  but  which  is  associated  with  considerable  danger.  With 
the  patient  on  his  ventral  surface  the  lower  half  of  the  body 
is  raised  from  the  table  by  inserting  the  arm  underneath  the 
thighs,  or  by  supporting  the  latter  in  a  suspension  apparatus. 
Then  as  this  lower  half  of  the  body  is  swung  from  side  to 
side  pressure  is  brought  to  bear  with  the  free  hand  upon  the 
spine  where  it  is  desired  to  produce  the  breaking  effect.  The 
pressure  with  the  thumbs  while  exerted  downward  is  also  ex- 
erted laterally  in  a  direction  opposite  that  of  the  swing  of  the 
body.  This  treatment  may  be  efficient  and  harmless  if  a.p~ 
plied  with  judgment,  but  unfortunately  there  are  a  large  num- 
ber of  students  and  practitioners  devoid  of  a  sufficient  amount 
of  that  useful  faculty,  and  hence  harm  is  likely  to  result  in 
occasional  cases.  Especially  will  this  be  the  case  when  the 
limbs  are  supported  by  a  suspension  apparatus'and  the  phy- 
sician has  all  his  strength  free  to  devote  to  the  local  pressure. 
He  is  likely,  therefore,  to  use  his  strength  and  weight  to  a 
disadvantage  to  the  patient.  A  good  rule  to  remember  in 
this  connection  is  that  the  weight  of  the  body  itself  while  in 


THORACIC   AND   LUMBAR   LESIONS — SPINAL.  273 

this  position  is  sufficient  for  the  spine  to  bear,  and  any  addi- 
tional pressure  applied  to  local  points  in  the  spine  should  be 
applied  in  a  lateral  direction  as  much  as  is  possible.  For  ef- 
fects upon  the  lateral  ligaments  and  other  structures  the  patient 
may  lie  upon  his  side  with  the  physician  standing  in  front. 
The  latter  with  one  hand  on  the  hip  or  the  shoulder  and  the 
other  reaching  over  and  grasping  the  spinous  processes,  pro- 
duces a  torsion  of  the  body  by  exerting  force  with  each  of 
the  hands  but  in  opposite  directions.  This  will  tend  not  only 
to  affect  the  lateral  but  also  the  anterior  structures  and  inter- 
vertebral  cartilages.  A  variation  of  this  treatment  consists 
in  making  use  of  the  arm  by  drawing  it  across  the  chest  and 
up  by  the  face,  in  this  way  exerting  a  lateral  tension  upon 
the  spinous  processes  through  the  medium  of  the  trapezius 
and  other  muscles,  at  the  same  time  assisting  at  the  local 
point  by  the  free  hand.  Or  with  the  patient  on  the  side  and 
standing  in  front  or  behind  a  simple  strong  bearing  down 
upon  the  spinous  processes  will  more  or  less  efficiently  spring 
the  spine.  For  affecting  the  posterior  structures  any  method 
that  produces  a  greater  posterior  convexity  will  be  efficient. 
The  method  referred  to  in  aonnection  with  the  flat  thoracic 
lesion  by  bending  the  head  strongly  forward  thus  exerting 
tension  upward  on  the  spinous  processes  may  be  employed 
to  advantage.  Similarly,  with  the  patient  on  the  back,  the 
method  of  "rolling  him  upon  his  shoulders"  by  strongly  flex- 
ing the  limbs  on  the  body  and  then  lifting  the  lower  part,may 
be  of  some  value. 

In  cases  where  the  posterior  convexity  is  increased, 
thus  constituting  a  lesion,  there  are  a  number  of  methods 
that  may  be  applied  successfully.  The  diagnosis  of  such  a 
condition  is  usually  not  difficult.  The  abnormality  will  usu- 
ally be  found  in  the  lower  part  of  the  thoracic  spine  though 
occasionally  the  upper  part  is  the  one  to  suffer.  While  the 
patient  is  sitting  in  his  usual  position  the  spine  will  appear 
quite  convex.  If  on  assuming  a  forcibly  erect  position  the 
convexity  disappears,  it  suggests,  not  a  posterior  curvature, 


274  PRINCIPLES   OP   OSTEOPATHY. 

but  a  weakened  and  lax  spine.  If  the  convexity  still  re- 
mains while  the  patient  is  forcing  himself  to  sit  erect,  it  is 
quite  good  evidence  of  an  abnormal  condition.  In  most  cases 
there  will  be  associated  a  lessened  state  of  mobility.  Further, 
the  condition  of  the  lower  ribs  will  be  noticeable,  the  usual 
condition  of  these  being  a  depression  of  the  anterior  extremi- 
ties, especially  marked  in  the  last  two  whose  ends  may  be  so 
depressed  as  to  occupy  a  position  nearly  on  a  level  with  the 
ilium.  Such  cases  usually  are  dependent  on  the  continua- 
tion of  the  posterior  convexity  throughout  the  lumbar  portion 
of  the  spine. 

A  method  for  overcoming  the  posterior  curvature, 
and  one  which  is,  with  variations,  equally  applicable  to  later- 
al curvatures  and  numerous  other  lesions,  consists  in  the 
following:  with  the  patient  on  the  table  or  stool  the  physician 
stands  in  front,  reaching  around  with  a  hand  on  either  side 
of  the  spinal  column,  the  patient  meanwhile  leaning  forward 
easily  against  the  chest  of  the  operator  in  order  to  take  off 
any  tension  of  muscles  otherwise  present  and  to  furnish  a 
chance  for  rotation  by  movement  of  the  body  of  the  physician ; 
then  by  a  direct  forward  and  lateral  pressure  on  the  spine,  at 
the  same  time  lifting  up  and  rotating,  a  very  powerful  force 
is  brought  to  bear.  Another  method  which  is  a  valuable  one 
is  used  with  the  patient  in  the  same  position  on  the  table  or 
stool.  In  this  the  physician  stands  behind  with  one  hand  on 
the  shoulder  for  purposes  of  rotation,  the  other  with  thumb 
or  fingers  on  the  lateral  aspect  of  the  vertebra.  Then  the 
shoulder  is  made  to  outline  a  circle  whose  plane  is  in  an 
antero-posterior  direction.  As  the  shoulder  is  brought  back- 
ward the  hand  at  the  vertebra  on  the  opposite  side  of  the 
spine  is  held  immovable.  Consequently  the  weight  of  the 
body  acts  as  the  force  to  drive  the  part  in  its  normal  direc- 
tion. Note  that  the  force  is  not  a  directly  anterior,  but  an 
antero- lateral  one,  which  is  always  advantageous.  Then  re- 
versing the  hands,  the  other  shoulder  is  used  and  the  part  is 
forced  forward  and  laterally  but  the  last  in  a  direction  oppo- 


THORACIC   AND   LUMBAR   LESIONS— SPINAL.  275 

site  to  that  in  the  first  case.  The  actual  movement  will  be 
more  complex  than  would  appear  from  the  description,  and 
at  some  time  during  the  circuit  every  part  of  the  articular  struc- 
tures will  have  been  acted  upon  in  a  more  or  less  advantageous 
manner.  Further,  at  one  part  of  the  circuit  exaggeration  of 
the  lesion  is  affected,  for  as  the  shoulder  goes  forward  pres- 
sure is  exerted  downward  which  tends  to  throw  the  spine  more 
posterior.  This  treatment  is  equally  applicable  to  lateral  and 
to  almost  any  condition  with  the  exception  of  the  anterior 
luxations.  With  the  patient  lying  prone,  direct  pressure 
downward  may  be  made  upon  the  transverse  processes,  but 
unless  lateral  movement  is  also  produced  it  will  not  be  quite 
satisfactory.  Similarly  the  patient  _may  be  treated  in  the 
position  lying  on  the  side. 

A  method  of  special  value  requiring  special  apparatus 
has  come  into  use  within  recent  years.  A  stool  with  a  back 
provided  with  a  sliding  part  arranged  to  fie  closely  on  either 
side  of  the  row  of  spinous  processes,  and  a  seat  bottom  un- 
yielding in  nature  and  with  a  wedge  shape  piece  to  prevent 
the  ischii  from  lateral  sliding,  constitutes  the  apparatus. 
These  are  provided  for  in  the  Dr.  Still's  Chair.  With  the 
adjustable  piece  at  the  point  of  lesion  and  the  physician  in 
front  or  behind,  the  shoulders  are  gasped  and  by  a  figure-of- 
eight  movement  the  body  is  rotated,  the  only  movable  part  of 
the  body  being  that  above  the  fulcrum,  the  remainder  being 
held  by  the  pressure  against  the  latter  and  downward  upon 
the  stool.  In  this  treatment  the  spine  above  the  fulcrum 
represents  the  lever  arm,  the  "breaking"  occuring  more  or 
less  entirely  at  the  fulcrum.  By  sliding  the  movable  part  up 
or  down  each  of  the  involved  vertebrae  may  be  acted  upon. 
Owing  to  the  interference  presented  by  the  arms  of  the  stand- 
ard supporting  the  movable  fulcrum,  there  is  little  possibility 
of  drawing  the  patient  too  far  posteriorly  and  hence  doing 
harm.  A  method  of  getting  a  fixed  point  by  applying  the 
knee  or  knees  to  the  part  has  long  been  in  use,  and  where  ap- 
plied with  caution  is  of  much  value.  With  the  patient  on  a 


276  PRINCIPLES   OF   OSTEOPATHY. 

low  stool  and  the  physician  standing  behind,  the  latter  places 
the  toe  of  his  shoe  on  the  stool  and  his  knee  at  the  side  of  the 
spinous  process.  Then  by  movement  of  the  shoulders  the 
body  is  rotated  about  the  knee  as  a  fixed  point.  With  the 
physician  sitting,  both  knees  may  be  used  except  where  the 
scapulae  are  too  closely  approximated  to  the  spine.  In  this 
treatment  there  is  always  danger  from  the  fact  that  the  physi- 
cian is  not  aware  of  the  amount  of  leverage  he  is  using.  It 
is  necessary  to  emphasize  the  point  that  the  knee  knows  noth- 
ing of  pressure.  In  case  of  the  fingers  and  hand  there  is  de- 
veloped by  training  a  sense  of  pressure  and  of  weight.  Hence 
with  the  fingers  as  the  fulcrum  the  judgment  of  the  physician 
is  enhanced.  Not  so  with  the  knee.  True,  the  hands  are 
placed  on  the  shoulders  when  the  knee  is  used  and  hence  are 
in  a  position  to  judge  of  the  pressure;  but  in  most  cases  the 
physician  will  be  thinking  of  keeping  the  knee  in  place  and 
will  ignore  the  hands.  It  is  further  true  that  the  tissues  over 
the  knee  as  well  as  those  over  the  spine  are  quite  movable ; 
unless  care  is  taken  during  the  application  the  knee  may  slip 
to  the  side  and  shock  be  produced  or  even  greater  injury 
done.  Altogether,  if  the  knee  treatment  is  used  at  all  it  is  to 
be  done  with  full  knowledge  of  the  cautions  necessary. 
THORACIC  LESIONS — LOCAL. 

In  addition  to  these  several  forms  of  general  thoracic 
spinal  lesions  there  are  many  of  a  distinctly  local  character. 
Of  these,  torsion  between  two  adjacent  vertebrae  is  common. 
In  such  a  case  there  will  be  lateral  deviation  of  the  spinous 
process;  differences  between  the  prominence  of  the  two  trans- 
verse processes  and  between  these  and  similar  adjacent  ones; 
greater  prominence  of  the  angle  of  the  rib  on  one  side;  local 
contractures  and  sensory  disorders.  In  overcoming  the  con- 
dition pressure  is  exerted  laterally  upon  the  spinous  and  an- 
teriorly upon  the  prominent  transverse  process  at  the  same 
time  that  rotation  is  being  effected  by  any  of  the  numerous 
methods  that  have  been  already  suggested. 

In  many  cases  separations  (See  Fig.  10)   between  ad- 


THORACIC  AND  LUMBAR  LESIONS— SPINAL.  277 

jacent  spinous  processes  will  be  detected.  This  is  perhaps 
more  likely  to  occur  in  the  upper  than  in  the  lower  thoracic. 
A  rotation  about  the  part  and  other  methods  for  producing 
re-adjustment  of  muscular  disorders  will  usually  be  effective. 
Anterior  luxations  of  single  vertebrae  are  occasionally 
noted  by  the  deeper  situation  of  the  spinous  and  transverse 
processes  and  the  pair  of  ribs  with  which  the  vertebra  articu- 
lates. Backward  and  inward  pressure  upon  the  sides  and 
angles  of  the  ribs  will  assist  the  rotary  manipulation  in  draw- 
ing or  forcing  it  back.  Various  other  conditions  may  be  met 
with  and  will  be  detected  and  corrected  by  methods  similar  to 
those  indicated  above. 

LUMBAR  LESIONS. 

The  lesions  affecting  the  lumbar  portions  of  the  spine  are 
in  general  the  same  as  those  associated  with  the  thoracic  por- 
tion. Owing  to  the  absence  of  ribs  the  muscular  structures 
are  relatively  more  developed  and  hence  in  this  part  muscu- 
lar lesions  as  a  rule  will  be  more  noticeable  because  of  the 
greater  amount  of  tissue  involved.  In  noting  the  condi- 
tion it  should  be  remembered  that  the  normal  curvature  of  the 
lumbar  region  is  an  anterior  one  beginning  with  the  lower 
thoracic  and  ending  with  the  prominence  of  the  sacrum.  Care 
should  be  taken  to  determine  whether  the  position  assumed  by 
the  patient  represents  a  normal  condition.  For  instance  with 
a  good  many  individuals  a  habit  is  formed  of  sitting  in  a 
rather  lax  condition  which  causes  the  lower  part  of  the  spine 
to  protrude  posteriorly.  In  the  examination  the  patient 
should  be  requested  to  sit  in  as  nearly  a  normal  position  as 
he  can ;  then  by  comparison  of  this  condition  with  that  of  an 
extreme  erect  and  extreme  lax  posture,  more  nearly  correct 
judgment  can  be  made.  It  is  in  this  portion  of  the  spinal 
area  that  the  median  furrow  spoken  of  by  Holden  becomes  of 
most  importance.  In  numerous  cases  this  groove,  at  the  bot- 
tom of  which  will  be  found  the  row  of  spinous  processes,  be- 
ginning with  the  lower  thoracic  region  and  extending  to  the 


278  PRINCIPLES   OF  OSTEOPATHY. 

sacrum  will  be  found  to  vary  in  depth,  width,  and  symmetry 
of  outline.  These  changes  are  always  suggestive  of  spinal 
lesion,  either  osseous  or  muscular.  In  many  instances  the 
lower  boundaries  of  the  groove  will  be  decidedly  prominent 
and  tense,  more  noticeable  when  the  patient  is  in  the  sitting 
posture.  At  the  same  time  the  groove  may  be  appreciably 
narrowed.  This  usually  is  dependent  upon  a  condition  of 
contracture  of  the  more  bulky  portions  of  the  erector  spinae 
muscle,  and  in  most  cases  this  again  is  due  to  deeper  lesion 
associated  with  the  lumbar  spine,  the  sacrum,  or  the  innomi- 
nate bones.  The  correction  will  therefore  be  dependent  upon 
the  adjustment  of  those  deeper  tissues.  A  further  point  to 
note  in  the  examination  of  this  part  is  the  condition  of  the 
spinous  processes.  These  are  directed  horizontally ,  which 
marks  a  distinct  difference  between  them  and  the  typical  tho- 
racic vertebra.  Further,  these  are  extremely  strongly  de- 
veloped and  in  many  cases  palpation  along  their  prominences 
will  suggest  a  continuous,  irregular,  bony  ridge,  rather  than 
a  series  of  separate  processes.  This  will  be  especially  true  of 
those  cases  where  lesion  is  present  in  the  form  of  thickened 
ligaments,  or  in  those  individuals  who  are  strongly  develop- 
ed naturally.  The  condition  of  the  transverse  processes  should 
be  noted.  These  in  comparison  with  those  of  the  thoracic 
region  are  longer  and  more  developed  otherwise.  They  are 
also  much  more  subject  to  variation.  Cases  are  on  record  where 
the  process  of  the  first  lumbar  was  mistaken  for  the  twelfth 
rib,  and  by  individuals  who  were  fairly  careful  diagnos- 
ticians. Usually  the  mobility  of  the  rib  will  prevent  any  such 
mistake.  These  processes  are  often  found  quite  tender  to 
touch  through  the  overlying  muscular  and  other  tissue.  In 
such  cases  it  is  quite  good  evidence  that  something  is  wrong, 
either  a  contraction  of  these  tissues,  which,  in  contact  with 
the  prominences,  produces  sensory  disorder;  or  because  of  a 
twisted  or  otherwise  subluxated  vertebra  the  process  is  more 
or  less  forcibly  pressed  into  the  parts  and  in  that  manner 
produces  irritation.  Further,  the  fact  should  be  remembered 


THORACIC   AND   LUMBAR  LESIONS— SPINAL.  279 

that  there  is  in  the  average  individual,  a  greater  separation  be- 
tween the  spinous  processes  of  the  last  thoracic  and  first  lum- 
bar, and  also  between  the  last  lumbar  and  spine  of  the  sacrum. 
While  this  condition  seems  to  be  a  normal  one  in  many  cases, 
yet  experience  would  seem  to  show  that  these  two  points,  es- 
pecially the  latter,  are  more  than  the  others  subject  to  lesion 
conditions. 

Curvatures,  lateral,  anterior,  and  posterior,  similar  in 
kind  and  extent  to  those  found  in  the  thoracic  spine  are  com- 
mon in  the  lumbar,  and  will  in  general  be  diagnosed  and  ad- 
justed in  the  same  way.  In  most  cases  the  lumbar  region 
will  compensate  for  a  thoracic  condition,  and  the  reverse  may 
be  true.  Hence  in  treatment  of  a  lumbar  curvature  reference 
should  be  made  to  the  condition  of  the  thoracic  spine  and  the 
treatment  regulated  in  accordance  therewith-.  In  most  cases 
it  is  not  a  matter  of  absolutely  vital  importance  as  to  which 
condition  is  the  primary  one  and  in  many  cases  such  deter- 
mination will  be  impossible-  Both  curvatures  are  attended 
to  in  the  treatment  and  are  corrected  at  the  same  time.  It  is 
probably  true  that  if  the  primary  curvature  alone  were  cor- 
rected the  secondary  condition  would  to  a  marked  extent  dis- 
appear, but  unquestionably  the  adjustment  will  be  brought 
about  much  more  quickly  and  efficiently  when  both  are  treated. 

Slight  luxations  such  as  lateral,  anterior,  posterior,  and 
twisted  conditions  of  single  vertebrae  are,  owing  to  the 
greater  amount  of  muscular  tissue  overlying,  usually  more 
difficult  of  detection  in  the  lumbar  than  in  the  thoracic  por- 
tion of  the  spine,  and  hence  reliance  must  be  made  quite 
largely  upon  the  contracture  and  other  disturbance  of  the 
softer  tissues.  This  latter  condition  will  in  most  cases  be 
quite  well  marked.  For  instance  in  the  case  of  a  torsion  one 
transverse  process  owing  to  its  considerable  development, 
will  be  forced  quite  prominently  into  the  softer  tissues  and 
hence  a  marked  contraction  and  congestion  will  result  which 
will  be  comparatively  easy  of  detection.  Anterior  and  pos- 
terior luxations,  if  more  carefully  diagnosed  will  fortunately 


280  PRINCIPLES   OF   OSTEOPATHY. 

often  be  found  to  be  mere  angular  antero-posterior  changes, 
consequently  throwing  the  spinous  process  more  or  less  promi- 
nent. This  is  especially  true  of  the  fifth  lumbar.  While  the 
statement  that  the  fifth  lumbar  cannot  go  anterior  is  one  that 
is  not  substantiated  by  the  facts,  yet  it  is  a  condition  much 
less  common  than  was  formerly  believed.  An  extreme  an- 
terior bending  at  the  junction  of  the  fifth  with  the  sacrum  is  a 
much  more  common  condition  than  is  the  real  anterior  dis- 
placement. The  angular  condition  causes  the  spinous  pro- 
cess to  be  more  or  less  obscure  and  gives  rise  to  the  belief 
that  the  vertebra  is  displaced  anteriorly.  In  most  of  these 
cases  if  the  patient  is  placed  in  such  a  position  that  the  lum- 
bar spine  may  be  drawn  posteriorly  the  spinous  process  of 
the  fifth  will  become  apparent.  Further,  if  the  direction  of 
the  upper  portion  of  the  sacrum  be  noted  the  real  condition 
will  become  obvious,  for  it  will  be  found  that  the  upper  por- 
tion of  the  sacrum  also  has  receded  anteriorly.  But  that 
there  are  many  cases  which  may  with  all  propriety  be  spoken 
of  as  anterior  fifth  lumbar  conditions,  we  are  entirely  per- 
suaded. The  extreme  cases  of  this  kind  that  are  met  with 
would  show,  if  the  pathology  could  be  determined,  that  there 
had  been  a  more  or  less  considerable  change  of  the  articulat- 
ing structures  as  a  whole,  including  the  osseous  parts. 

For  purposes  of  overcoming  such  anterior  structures 
two  or  three  methods  may  be  suggested.  With  the  patient 
sitting  on  a  stool  the  physician  stands  at  the  side  facing  in  the 
opposite  direction  while  with  the  adjacent  arm  he.  reaches 
across  the  chest  and  grasps  the  body  underneath  the  axilla. 
Then  strongly  bending  the  patient  forward  so  as  to  throw  the 
spine  posteriorly,  rotation  and  lateral  movement  is  given 
while  pressure  is  exerted  with  the  free  hand  upon  the  tissues 
lateral  to  the  vertebra  involved.  Another  method  which  has 
long  been  in  use  and  productive  of  much  good  is  one  which  is 
rather  wearing  on  the  physician.  With  the  patient  lying  on 
his  side  the  physician  stands  in  front  and  strongly  flexes  the 
thighs  upon  the  abdomen.  Then  reaching  over  with  one 


THORACIC   AND   LUMBAR  LESIONS— SPINAL.  281 

hand  underneath  the  buttocks,  the  lower  half  of  the  body  is 
lifted  slightly  from  the  table  thus  allowing  the  weight  of  the 
body  to  bend  the  spine  laterally  in  the  lumbar  region.  With 
the  other  hand  the  physician  reaches  over  and  grasps  the 
spinous  process  of  the  fifth  on  its  under  surface,  at  the  same 
time  lowering  the  buttocks.  By  repetition  of  this  movement 
a  considerable  effect  is  produced  in  opening  up  the  tissues 
while  the  position  in  which  the  patient  is  held  compels  a  con- 
tinuously acting  posterior  force. 

In  all  of  the  luxations  associated  with  the  lumbar  region, 
as  also  true  of  other  parts,  it  may  be  necessary  to  overcome 
a  part  of  the  muscle  contracture  previous  to  adjustment  of 
deeper  structures.  This  may  be  accomplished  in  any  of  the 
several  ways  which  have  been  mentioned. 


19 


282  PRINCIPLES   OF   OSTEOPATHY. 


CHAPTER  XIV, 


THORACIC  AND  LUMBAR  LESIONS— COSTAL. 

It  is  not  very  common  that  a  serious  thoracic  spinal  lesion 
will  be  present  without  a  corresponding  rib  lesion,  the  inti- 
mate anatomical  and  physiological  associations  existing  be- 
tween the  two  making  them  more  or  less  interdependent  with 
reference  to  their  lesions.  It  is  much  more  true  that  the  rib 
is  dependent  upon  the  spine  than  that  the  spine  is  dependent 
upon  the  rib  for  the  normal  condition.  It  is  quite  often  that  a 
rib  or  several  of  the  ribs  will  be  found  in  a  subluxated  condi- 
tion without  material  disorder  of  the  associated  vertebrae,  but 
only  rarely  that  the  spinal  lesion  leaves  the  normal  condition 
of  the  rib  intact.  It  is  to  be  noticed  that  the  ribs  are  sus- 
pended from  their  anterior  ends  and  are  supported  from  their 
vertebral  ends.  This  support  is  the  spinal  column,  through 
the  double  articulation  between  the  rib  and  the  vertebra. 
Hence  any  material  lesion  of  the  support  will  almost  certain- 
ly involve  the  rib. 

EXAMINATION. 

In  no  region  of  the  body  is  it  more  necessary  to  bear  in 
mind  the  value  of  examination  in  different  positions 
than  in  case  of  the  chest  region.  Unlike  the  vertebral  column 
the  ribs  are  in  continuous  and  obvious  activity  easily  observ- 
able on  inspection  and  palpation.  Hence  in  the  examination 
of  the  part  during  its  functional  rest  it  is  a  matter  rather  of 
degree,  since  the  resting  phase  of  the  respiratory  cycle  is  a 
definite  movement.  The  examination  will  in  either  ease  be 
made  while  the  part  is  moving.  But  by  causing  the  patient 
to  respire  deeply  the  action  will  thus  be  increased  above  the 
normal  and  any  abnormal  condition  associated  with  the  part 
will  likely  be  made  more  prominent.  This  may  not  only  be 
noticeable  to  the  examining  physician  but  the  patient  himself 


THORACIC  AND  LUMBAR  LESIONS — COSTAL.  283 

will  probably  experience  an  increase  in  the  subjective  symptoms 
associated  with  the  disorder.  In  numerous  cases  of  recent  rib 
subluxations  considerable  amount  of  pain  will  be  manifest 
and  this  will  be  markedly  intensified  if  the  patient  is  made  to 
thus  inhale.  But  on  the  other  hand  in  producing  this  forced 
activity,  part  or  all  of  the  lesion  condition  may  be  obscured. 
Hence  the  examination  must  be  made  with  the  part  in  as 
completely  a  relaxed  condition  as  is  possible.  In  many  cases 
thus  associated  with  pain  the  patient  will  indicate  it  by  the 
position  he  voluntarily  assumes,  favoring  the  side  associated 
with  the  lesion  by  sitting  in  a  peculiar  position  or  by  a  volun- 
tary lessening  of  the  depth  of  respiration.  For  purposes  of 
comparing  the  movement  of  the  ribs  inspection  "and  palpation 
both  have  their  advantages.  The  rise  and  fall  of  the  chest 
wall  is  easily  noticed  on  inspection.  In  many  cases  the 
patient  will  not  be  able  to  produce  very  marked  movement  of 
the  upper  ribs  even  though  the  effort  to  do  so  costs  him  no 
discomfort.  In  such  a  case  the  upper  ribs  have  become  more 
or  less  permanently  fixed.  In  many  cases  the  rise  and  fall 
of  the  chest  will  be  more  easily  detected  by  palpation  in  ap- 
plying the  palms  of  the  hands  over  the  anterior  chest  region. 
While  making  the  examination  by  inspection  or  palpation 
comparison  of  lateral  halves  of  the  chest  is  of  much  value. 
In  certain  disease  conditions  there  will  be  an  appreciable 
difference  in  \faaamplitudt  of  movement  between  the  two  sides. 
This  is  especially  true  of  certain  lung  disorders  in  which  a 
greater  or  less  degree  of  consolidation  has  occured.  In  pneu- 
monia where  a  complete  lobe  of  a  lung  is  involved  there  may 
be  practically  no  movement  at  all  on  the  involved  side  while 
on  the  normal  side  through  a  process  of  compensation  there 
will  be  an  increased  activity,  usually  not  of  depth  but  of 
rapidity.  The  general  shape  of  the  chest  should  be  noticed 
with  reference  to  the  presence  of  depressions  or  prominences 
either  of  which  indicates  a  disturbed  condition.  The  size  of 
the  chest  as  well  should  be  noted.  In  some  cases  one  lateral 
half  of  the  chest  will  be  so  depressed  as  to  materially  lessen 


284  PRINCIPLES   OF  OSTEOPATHY. 

its  circumference.  It  should  be  noted  in  this  connection  that 
with  most  individuals,  on  the  side  of  the  body  which  is  used 
the  most  there  will  be  a  greater  chest  development,  e.  g., 
right  handed  individuals  will  usually  show  a  greater  circum- 
ference of  the  right  hand  half  of  the  chest. 

SOME  GENERAL  TYPES. 

Any  practitioner  of  experience  will  undoubtedly  have 
been  impressed  by  the  fact  that  the  general  shape  and  con- 
formation of  the  chest  as  a  whole  varies  remarkably  with  in- 
dividuals both  with  reference  to  normal  and  abnormal  states. 
In  relation  to  the  normal  shape  the  cylindrical  chest  of  the 
young  child  is  characteristic,  while  that  of  the  adult  shows  a 
marked  difference  between  the  transverse  and  the  antero- pos- 
terior diameters,  together  with  the  noticeable  change  from 
the  roundness  of  outline  dependent  upon  the  development  of 
the  angles  of  the  ribs  and  the  more  oblique  position  of  the 
latter  with  reference  to  the  spinal  column.  This  latter  will 
partly  account  for  the  abdominal  type  of  breathing  in  child- 
ren and  in  male  adults  as  compared  with  the  thoracic  type  as- 
sociated with  the  female  adult  in  whom  there  is  usually  a  more 
depressed  condition  of  the  anterior  ends  of  the  ribs.  These 
facts  are  of  considerable  value  to  the  student  since  a  failure 
to  recognize  them  may  lead  to  a  serious  error  in  both  diagno- 
sis and  treatment.  Of  the  general  types  of  abnormal  chest 
conditions  there  are  recognized  three  which  are  characteristic : 
the  first  is  the  flat  chest  which  is  a  condition  commonly 
found  associated  with  disorders  of  the  lungs.  This  form  is 
remarkably  often  associated  with  tuberculosis  of  the  lungs. 
In  a  good  many  cases  it  would  seem  to  be  a  question  whether 
the  flattened  condition  were  primary  or  secondary.  It  is  un- 
doubtedly true  that  a  wasting  away  of  the  lung  tissues  which 
is  common  in  consumption  will  result  in  the  gradual  depres- 
sion of  the  chest  especially  in  the  upper  part.  It  is  equally 
certain  that  in  many  cases  the  flat  condition  exists  prior  to 
any  infection  of  the  tissue.  Indeed  we  are  persuaded  that  the 


THORACIC   AND   LUMBAR   LESIONS— COSTAL.  285 

so-called  hereditary  transmission  of  tuberculosis  is  little  else 
than  the  transmission  of  a  narrowed  thorax.  In  this  case  the 
condition  of  the  lung  tissues  is  such  as  to  render  them  more 
susceptible  to  the  influence  of  the  tubercle  bacillus.  It  is  a 
significant  fact  that  the  pulmonary  lesion  usually  begins  near 
the  apices  of  the  lungs  which  is  the  principal  region  involved 
in  the  flattening.  This  flattening  is  a  condition  that  prevents 
the  normal  nutritive  processes  and  hence  the  ill-nourished 
condition  furnishes  the  favorable  soil  for  the  propagation  of 
the  micro-organism.  As  a  modification  of  this  type  there  is 
the  tapering  chest  in  which  the  difference  in  the  diameters  is 
not  so  marked  while  the  cavity  of  the  chest  partakes  of  the 
nature  of  a  cone  the  apex  of  which  is  at  the  cervico- thoracic 
junction.  This  condition  is  also  a  common  one  in  pulmonary 
disorders  of  various  kinds. 

A  second  type  is  the  barrel-shaped  chest.  This  is 
what  might  be  termed  a  modification  of  the  infantile  or  cylin- 
drical type.  It  is  much  less  common  than  is  the  flat  chest  and 
is  perhaps  as  often  secondary  as  primary  to  the  disease  con- 
dition associated  with  it.  This  type  is  most  markedly  noticed 
in  a  chronic  asthmatic  condition  and  especially  where  that 
disease  has  terminated  in  emphysema.  Asthma  is  a  disorder 
in  which  considerable  bronchial  constriction  is  present  due  to 
an  irritant  effect  upon  the  nerves  distributed  to  the  muscle 
tissue  in  the  bronchial  walls.  Under  these  circumstances  the 
air  is  only  with  extreme  difficulty  forced  into  and  out  from 
the  alveoli.  Owing  to  the  extreme  force  that  is  brought  to  bear 
upon  the  alveolar  walls  there  ultimately  results  an  exhausted 
and  stretched  condition  of  the  tissue.  We  know  that  one  of 
the  principal  forces  in  producing  the  expiratory  phase  of  res- 
piration is  the  normal  elasticity  of  the  lung  tissue  which  has 
been  put  upon  the  stretch  during  the  inspiratory  phase  when 
the  diaphragm  is  lowered  and  the  chest  wall  lifted  upward 
and  outward.  Normally  this  together  with  the  other  elastic 
structures  is  sufficient  to  produce  the  expulsion  of  the  air  in 
quiet  respiration.  When,  therefore,  this  elastic  condition 


286  PRINCIPLES   OF   OSTEOPATHY. 

has  been  partially  or  completely  destroyed  the  tendency  of 
the  more  or  less  unopposed  inspiratory  muscles  will  be  to 
keep  the  lung  tissues  permanently  distended  through  a  per- 
manent condition  of  lifted  ribs.  With  less  elastic  tissue  to 
draw  the  chest  walls  downward  and  inward  the  position  of 
the  rib  is  gradually  changed  from  a  greater  to  a  less  oblique 
condition,  which  partially  accounts  for  the  typical  and 
characteristic  barrel  shape.  In  addition  to  this  there  is  un- 
doubtedly a  disturbance  in  the  articulation  between  the  rib 
and  the  vertebra  and  especially  at  the  costo-  transverse  ar- 
ticulation. This  latter  fact  is  undoubtedly  true  in  the  asth? 
matic  attack  in  which  the  barrel  shape  is  quite  often  manifest 
while  during  the  intervals  of  the  disorder  the  general  shape 
of  the  chest  may  not  appear  abnormal. 

The  third  type  of  the  abnormal  chest  is  one  dependent  up- 
on nutritional  disorders  of  the  bony  tissue  itself  and  is  of  such 
a  character  as  to  give  it  the  partially  descriptive  name  of  box- 
shaped  chest.  This  is  the  type  that  is  found  associated 
with  rachitis  commonly  spoken  of  as  rickets.  The  disorder  in 
this  condition  is  not  apparently  dependent  upon  disturbance 
of  the  articulation  of  the  rib  but  upon  the  change  in  shape  of 
the  rib  during  its  growth.  The  box  shape  in  due  to  a  flatten- 
ing of  the  sides  of  the  chest  and  with  production  of  a  rather 
abruptly  angular  condition  at  the  costo -chondral  junction. 
This  change  in  shape  is  due  to  the  yielding  nature  of  the  ab- 
normal bony  tissue  which  is  influenced  by  the  respiratory  ac- 
tion. The  nutritional  disorder  is  not  confined  to  the  ribs  but 
is  noticed  in  connection  with  other  osseous  tissue,  especially 
the  cranium  and  long  bones. 

SINGLE  RIBS. 

The  landmarks  for  examination  of  a  single  rib  are  the 
angle,  the  costo -transverse  articulation,  and  the  anterior  end. 
While  these  are  the  parts  which  will  give  the  most  information 
with  reference  to  the  condition  of  the  rib  it  is  always  advisa- 
ble to  follow  with  the  fingers  the  outline  of  the  rib  throughout 


THORACIC  AND   LUMBAR  LESIONS — COSTAL.  287 

its  entire  extent.  With  the  possible  exception  of  the  first,  the 
head  and  neck  of  the  rib  are  too  deeply  situated  in  their  an- 
terior relation  to  the  transverse  process  and  the  antero -lateral 
relation  to  the  body  of  the  vertebra  to  be  detected.  In  order 
to  better  understand  the  lesion  conditions  that  are  found  it  is 
advisable  to  get  a  complete  picture  of  the  normal  articulations 
and  the  normal  movements  that  take  place  in  connection. 
The  rib  has  but  the  two  typical  articular  mechanisms, 
namely,  the  costo- central  and  the  costo- transverse — the  junc- 
tion of  the  anterior  end  of  the  rib  with  the  costal  cartilage  and 
the  latter  with  the  sternum  or  other  cartilage  not  being  a 
typical  articulation.  Each  rib  with  the  exception  of  the  first, 
eleventh,  and  twelfth,  articulates  with  the  bodies  of  two  adja- 
cent vertebra  in  a  wedge-shaped  manner  and  is  bound  thereto 
by  ligaments  sufficiently  strong  to  prevent  any  great  possi- 
bility of  serious  luxation,  a  definite  capsule  being  present 
which  attaches  the  rib  to  both  vertebras  and  the  interverte- 
bral  disc.  This  articulation  permits  of  a  pivot  movement. 
The  articulation  with  the  transverse  process  is  one  which  per- 
mits of  considerable  freedom  of  movement  and  which  is  the 
one  more  commonly  involved  in  subluxation.  Movement  of 
the  rib  at  this  articulation  is  of  a  complex  nature.  Two  move- 
ments are  recognized,  one  of  which  consists  merely  in  a  roll- 
ing of  the  rib  upon  the  articular  surface  of  the  transverse 
process.  In  this  the  axis  of  rotation  passes  through  the  two 
articulations.  A  second  movement  is  of  a  gliding  character 
in  which  the  axis  of  rotation  is  represented  by  a  line  passing 
from  the  costo-central  articulation  to  the  chondro-sternal  junc- 
tion. By  virtue  of  this  double  movement  not  only  is  the 
antero -posterior  diameter  of  the  chest  increased  by  the  lift- 
ing up  of  the  anterior  end  of  the  rib  from  a  less  to  a  greater 
angle  with  the  spinal  column,  but  also  the  transverse  diameter 
is  similarly  increased  by  the  lifting  up  of  the  lateral  portion 
of  the  rib,  thus  causing  it  to  slide  as  well  as  to  roll  upward 
upon  the  transverse  process.  In  the  vast  majority  of  cases 
it  will  be  found  that  the  lesion  consists  in  an  extreme  condition 


288 


PRINCIPLES   OF   OSTEOPATHY. 


of  the  rib  in  its  relation  to  this  articular  surface.  In  some 
cases  the  rib  will  be  felt  rather  prominently  above  the  trans- 
verse process,  in  others  it  is 
apparently  on  a  level.  In 
either  case  the  relation  it 
bears  to  the  immediately  ad- 
jacent ribs  should  be  noticed. 
In  examining  for  the  rib  at 
the  costo-transverse  articula- 
tion the  student  will  find 
considerable  difficulty  in  lo- 
cating the  part.  While  in 
the  skeleton  the  prominence 

rig.  24.-showing  axes  of  rotation  of  the  end  of  the  transverse 
in  movement  of  rib.  (After  Kirke.)  and  the  depression  just  ex- 
ternal to  that  prominence  are  easily  noted  on  palpation,  it  is 
not  true  of  the  living  subject,  for  the  depression  will  be  large- 
ly filled  with  connecting  structures  and  the  prominence  over- 
laid with  muscular  and  other  tissue.  If  care  is  taken  in  the 
examination  the  prominence  of  the  transverse  process  will 
usually  be  noticed;  then  with  careful  palpation  just  external 
the  rounded  outline  of  the  rib  may  be  detected.  Passing  on 
externally  or  laterally  the  fingers  will  note  the  rather  abrupt 
bend  which  the  rib  makes  at  its  angle.  This  part  of  the  rib 
is  the  most  easily  detected  by  the  student  and,  fortunately  for 
diagnosis,  disturbances  in  the  position  of  the  rib  will  usually 
produce  obvious  change  in  the  relations  existing  between  ad- 
jacent angles.  The  angle  of  the  rib,  as  already  emphasized, 
is  of  value  in  diagnosis  because  of  its  greater  comparative 
prominence.  It  is  of  further  interest  in  that  it  marks  a  distinct 
change  in  the  direction  of  the  course  of  the  rib.  Note  that 
the  rib  at  the  angle  is  bent  and  twisted  upon  itself  so  that  when 
laid  upon  the  table  the  isolated  rib  will  not  touch  at  all  points, 
i.  e. ,  all  parts  are  not  in  the  same  plane.  This  fact  makes 
possible  a  very  different  general  shape  of  the  chest  than 
would  otherwise  be.  It  further  permits  of  a  more  complex 


THORACIC   AND   LUMBAR   LESIONS— COSTAL. 


289 


'5* 


change  in  position  of  one  part  of  the  rib  when  another  is  dis- 
placed, e.  g.,  a  slight  rotation  about  the  axis  passing  through 
the  two  articulations  at  the  posterior  part  will  cause  a  different 
change  in  the  position  of  the  anterior  end  than  would  other- 
wise be  the  case. 

The  various  forms  of  lesions  have  been  given  names 
which  are  more  or  less  provisional.  We  may  speak  of  a 
downard  sublimation.  It  is  manifest  that  several  ideas  might 
be  conveyed  by  such  a  term.  The  rib  as  a  whole  may  be 

thus  subluxated.  This  is  the 
condition  that  should  be  associ- 
ated with  the  term.  In  such  a 
case  the  disorder  will  be  de- 
tected by  reference  to  its  rela- 
tion to  the  immediately  adja- 
cent ribs.  The  intercostal  space 
above  will  be  increased  through 
out  its  whole  extent  while  that 
below  will  be  decreased.  In 
the  region  of  the  angles  the  de- 
pressed rib  will  seem  to  be  in 
direct  contact  with  the  one  be- 
low. In  this  condition  the  space 
throughout  its  extent  will  be 
more  uniform  than  in  other 
forms  of  disorder.  In  another 
case  of  downward  displace- 
ment the  rib  is  said  to  be  de- 
pressed. This  has  reference 
usually  to  the  anterior  and  not 
fifth>  to  the  posterior  part  of  the  rib. 
For  in  many  cases  the  antero- 
inferior  condition  will  be  associated  with  a  postero- superior 
change.  In  such  a  case  the  rib  at  its  articulation  with  the 
transverse  process  seems  to  be  resting  unusually  high  upon 
the  upper  part  of  the  articular  surface.  This  is  but  an  exag- 


Fig.   25. — Stabilisation   of  first, 
and  twelfth  ribs. 


290  PRINCIPLES   OP  OSTEOPATHY. 

gerated  upward  gliding  of  the  rib  which  in  less  degree  con* 
stitutes  a  normal  movement.  In  this  condition  it  will  be 
noticed  that  the  space  above  the  anterior  part  of  the  rib  will 
be  markedly  widened  while  that  below  the  posterior  part,  i. 
e.,  from  angle  tp  transverse  process,  will  be  in  the  similar 
condition.  Further,  at  the  anterior  end,  most  noticeably  at 
the  costo-chondral  junction,  the  depression  in  the  chest  wall 
will  in  many  cases  be  apparent,  while  at  the  angle  it  will  be  un- 
usually prominent  due  to  the  throwing  outward  of  the  inferior 
margin  of  the  rib  in  that  region.  This  condition  is  perhaps 
the  most  common  of  all  rib  luxations  and  is  the  form  com- 
monly referred  to  as  a  twisted  rib.  It  may  be  noticed  in  pass- 
ing that  the  latter  term  is  often  used  where  the  actual  dis- 
placement is  so  slight  as  to  render  certain  diagnosis  impos- 
sible. 

The  tenderness  on  pressure  is  a  valuable  aid  in 
diagnosis  of  any  of  the  ribs.  This  will  often  be  the  fact  most 
easily  detected.  Most  osteopaths  have  met  cases  where  the 
tenderness  was  practically  the  only  evidence  of  a  disturbed 
condition.  In  a  typical  rib  lesion  the  area  of 'tenderness  will  be 
quite  well  outlined  and  will  be  found  to  follow  the  course 
of  the  rib  throughout  its  whole  extent.  In  many  cases  the 
tenderness  will  be  uniform  along  its  course  but  in  others  there 
will  be  local  areas  of  increased  soreness,  suggesting  the  typi- 
cal intercostal  neuralgic  condition.  If  pressure  is  exerted  on  any 
part  of  the  subluxated  structure  the  pain  will  be  increased. 

In  most  cases  of  rib  luxations  there  will  be  in  addition  to 
the  above  named  indications,  various  conditions  of  muscu- 
lar contracture  and  changes  in  temperature  and  color  of 
the  parts  involved.  The  more  bulky  muscles  that  are  found 
on  the  posterior  part  of  the  thoracic  region  are  usually  easily 
detected  in  their  abnormal  condition.  The  intercostal  and 
others  of  the  deep  muscles  may  not  be  sufficiently  deranged 
to  be  detected  by  the  inexperienced.  Other  evidences  being 
detected,  it  may  usually  be  assumed  with  little  possi- 
bility of  error  that  such  a  condition  is  present.  Occasionally 


THORACIC  AND  LUMBAR  LESIONS— COSTAL.  291 

one's  attention  will  be  called  to  a  marked  difference  in  the 
temperatiire  between  the  tissues  associated  with  adjacent  ribs. 
If  care  be  taken  in  inspection  it  will  also  be  found  more  high- 
ly colored  in  the  area  of  greater  temperature,  suggesting  that 
the  latter  condition  is  due  to  an  excess  of  blood  from  vaso- 
dilatation  or  other  cause  of  congestion. 

SPECIAL  RIBS. 

The  above  considerations  are  given  with  special  reference 
to  the  typical  rib.  It  should  be  noted  that  there  are  several 
which  are  atypical.  Of  these  the  first,  eleventh,  and  twelfth 
are  important.  In  these  the  common  peculiarity  of  a  lack  of 
the  typical  angle  is  noted,  while  in  the  latter  two  there  is  but 
the  one  articulation  with  the  spine  and  that  the  costo- central, 
and  no  attachment  to  sternum  or  upper  ribs  in  front.  Hence 
various  points  of  difference  are  found  in  the  nature,  diagnosis, 
and  treatment  of  lesion  conditions  associated  with  these  special 
ribs. 

In  case  of  the  first  rib  several  new  factors  must  be  noted. 
It  is  without  the  typical  angle,  articulates  with  but  one  verte- 
bra, and  with  absence  of  inter  articular  ligament  a  greater  pos- 
sibility of  vertical  gliding  of  the  vertebral  end  is  presented.  This 
will  help  to  explain  the  common  condition  of  an  upward  sub- 
luxation  behind.  It  must  be  further  remembered  that  the 
costo-central  articulation  is  not,  in  this  case,  the  peculiar 
wedge  mechanism  which  is  characteristic  where  the  rib  makes 
union  with  two  adjacent  bodies.  The  third  peculiarity  is 
worthy  of  mention  since  it  has  to  do  with  the  cause  of  sublux- 
ations.  The  mass  of  shoulder  muscles  together  with  the 
presence  of  the  shoulder  girdle  prevents  much  possibility  of 
direct  violence  to  the  rib.  Hence  in  most  cases  the  disorder 
may  be  traced  to  a  disturbed  muscular  condition.  This  is 
usually  associated  with  the  scaleni.  The  function  of  these 
muscles  is  to  fix  the  rib  against  the  action  of  the  intercostal 
and  other  muscles  in  respiration.  They  are  usually  in  a  more 
tense  condition  than  the  average  muscle,  whether  in  the  in- 


292  PRINCIPLES    OF   OSTEOPATHY. 

spiratory  or  expiratory  phase  of  respiration  and  will  therefore 
usually  prevent  a  downward  displacement  of  the  rib.  On  the 
other  hand  they  are  the  prime  cause  of  the  upward  displace- 
ment. Undue  contraction  of  these  muscles  will  produce  dis- 
turbance of  either  the  cervical  vertebrae  or  the  first  rib.  Usual- 
ly it  is  the  latter  that  is  disturbed.  It  must  constantly  be  borne  in 
mind  that  the  scalenal  disorder  will  not  persist  without  a  cause 
acting  more  or  less  continuously.  In  most  cases  there  will  be  a 
deeper  lesion  which  affects  the  innervation  to  thescaleni,  i.  e., 
in  the  cervical  region.  It  was  said  that  owing  to  the  strength 
and  continued  tension  of  the  scaleni  the  first  rib  will  seldom 
be  displaced  downward.  But  note  the  following :  nearly  every 
first  rib  subluxated  upward  is  subluxated  posteriorly  which  permits 
the  anterior  end  as  well  as  the  whole  upper  anterior  part  of  the  thorax 
to  fall  posteriorly,  and  hence  lessen  the  antero-posterior 
diameter  of  the  chest  and  produce  crowding  on  the  structures 
passing  through  the  superior  opening  of  the.chest.  Occasion- 
ally cases  are  met  which  seem  to  indicate  &  downward  displace- 
ment of  the  rib  as  a  whole  in  which  the  cause  may  have  been 
traumatic  force  from  above  or  muscular  tension  from  below, 
in  either  case  sufficient  to  cause  the  scaleni  to  yield.  Other 
disorders  of  the  upper  rib  may  result  from  the  undue  con- 
traction or  relaxation  of  the  muscles  attaching  to  the  anterior 
part  of  the  clavicle  and  upper  part  of  the  sternum.  Among 
these  are  the  sterno-mastoid,  sterno-hyoid,  sterno- thyroid, 
omo-hyoid,  and  thyro-hyoid.  The  more  anterior  fibres  of 
the  clavicular  portion  of  the  trapezius  may  also  assist  in  an 
elevation  of  the  first  rib  through  the  attachment  of  the  latter 
to  the  clavicle  by  the  subclavian  muscle. 

Incase  of  the  floating  ribs,  i.  e.,  the  eleventh  and 
twelfth,  still  other  differences  from  the  typical  condition  pre- 
sent themselves.  These  have  but  the  one  vertebral  articulation 
and  are  attached  only  to  one  vertebra  each, and  hence  lack,as 
in  case  of  the  first, the  inter -articular  ligament.  Owing  to  their 
practical  freedom  from  attachment  to  the  transverse  processes 
behind  and  cartilages  of  the  superior  ribs  in  front,  these  two 


THORACIC  AND   LUMBAR  LESIONS— COSTAL.  293 

have  the  greatest  amount  of  mobility  of  the  ribs.  This  fact  is 
one  of  functional  importance  since  the  region  of  the  body 
which  they  occupy  is  one  where  much  crowding  of  tissues  is 
necessary  in  the  various  flexions  of  the  body  which  are  con- 
tinually taking  place.  As  a  consequence  of  their  looseness  of 
articulation  and  extreme  mobility  in  general,  they  are  easily 
subluxated,  and,  fortunate  circumstance,  easily  reduced  by 
the  organism  itself.  Owing  further  to  their  practical  suspen- 
sion between  muscular  tissues  they  are  largely  dependent  for 
position  upon  the  play  of  forces  concerned  with  the  muscles. 
Direct  violence  will  easily  displace  them.  Tightened  clothing 
will  force  them  inward  and  downward.  But  unless  a  con- 
siderable subluxation  takes  pi  ace  at  the  loose  vertebral  ar- 
ticulation they  will  in  all  cases  return  to  a  normal  position  if 
irritation  be  removed  from  muscular  tissue.  Among  the  most 
common  of  the  displacements  is  that  in  a  downward  direction 
(See  Fig.  25).  By  this  is  usually  meant  a  downward  depres- 
sion of  the  anterior  end  although  it  is  by  no  means  rare  that 
the  posterior  part  may  also  be  depressed.  This  condition  may 
be  much  more  extreme  than  the  average  student  would  believe 
possible  until  he  has  examined  personally  a  number  of 
cases.  It  is  hardly  an  exaggeration  to  say  that  the  twelfth  rib 
may  be  almost  vertical  and  parallel  to  the  vertebral  column. 
Many  cases  have  been  noted  where  the  anterior  end  was  almost 
if  not  quite  on  a  level  with  the  highest  point  of  the  iliac  crest. 
The  explanation  of  such  a  condition  may  be  difficult.  Nor- 
mally the  rib  ends  in  a  small  point  of  cartilage  which  lies  be- 
tween the  aponeurotic  structures  of  the  oblique  and  transverse 
muscles  of  the  abdominal  wall,  connected  to  these  by  areolar 
tissue.  In  the  extreme  downward  forcing  of  the  rib  in  most 
cases  it  would  seem  to  be  a  tearing  loose  from  this  areolar 
tissue  and  forcing  down  of  the  end  between  the  layers  of  the 
muscular  and  aponeurotic  tissue.  In  some  cases  it  will  be 
noted  that  there  will  be  a  general  atonic  condition  of  the 
abdominal  walls,  in  which  case  the  rib  is  simply  carried  along 
with  the  yielding  tissue.  The  wearing  of  corsets  and  other 


294  PRINCIPLES   OF   OSTEOPATHY. 

tight  clothing  is  one  of  the  most  common  causes  for  this 
downward  depression.  From  this  cause  the  rib  will  only 
gradually  be  depressed  and  hence  it  is  a  gradual  yielding  of 
the  tissue,  not  a  tearing  that  results.  The  tightened  clothing 
will  not  necessarily  produce  a  depression  downward  but  may 
depress  the  parts  inward  which  is  a  condition  equally  as 
faulty.  Another  cause  of  the  depressed  rib  is  that  of  over- 
active  infra-costal  muscles ,  i.  e.,  abdominal  and  quadratus 
lumborum.  The  attention  of  the  writer  has  several  times 
been  called  to  a  depressed  rib  condition  where  the  entire 
trouble  seemed  to  be  a  subluxated  innominatum  producing  the 
condition  through  irritation  to  the  nerve  distribution  of  the 
muscle  or  as  likely  to  direct  tension  on  the  connecting  tissues 
of  the  latter  with  a  consequent  downward  displacement  of  the 
rib.  Correction  of  the  iliac  bone  has  in  a  large  number  of 
cases  very  materially  aided -if  not  entirely  accomplished  re- 
duction of  the  rib  condition. 

In  examination  of  the  depressed  rib  the  anterior  end 
of  the  twelfth  will  usually  be  found  at  a  point  about  on  the 
mid-axillary  line,  i.  e. ,  the  rib  reaches  about  half  way  to  the 
median  line  in  front.  In  most  cases  its  end  can  easily  be  felt 
on  careful  palpation  but  where  it  is  disturbed  in  its  relations 
especially  if  the  case  be  a  recent  one,  much  tenderness  of 
tissue  will  be  encountered,  hence  aare  must  be  exercised  or 
additional  irritation  and  contracture  will  result.  The  rib  can 
then  be  followed  around  to  a  point  near  its  central  articulation 
and  further  data  secured  for  diagnosis.  The  anterior  end  of 
the  eleventh  will  be  found  above  and  more  toward  the  anterior 
than  the  posterior  part  of  the  body.  In  noting  the  condition 
of  either,  the  point  should  be  remembered  that  these  are 
atypical  ribs  and  hence  more  subject  to  differences  in  normal 
size,  shape,  and  position  than  the  others.  In  many  cases  the 
twelfth  will  be  so  short  as  to  make  possible  the  mistake  of 
calling  it  the  transverse  process  of  a  lumbar  vertebra.  Similar- 
ly, we  have  known  of  the  latter  being  mistaken  for  a  twelfth 
rib.  Simple  attention  to  the  fact  that  the  rib  may  thus  vary 


THORACIC   AND   LUMBAR  LESIONS— COSTAL.  295 

in  length  and  mobility  will  make  it  extremely  improbable 
that  a  careful  diagnostician  will  be  mistaken.  Yet  such  has 
been  the  case.  Further,  the  ilio-costal  space  should  always  be 
examined  to  determine  whether  it  is  widened  or  narrowed. 
Naturally  this  space  varies  with  individuals.  In  a  medium 
sized,  man  it  will  be  equal  to  the  breadth  of  two  to  four  fingers. 
Where  an  inequality  between  the  two  sides  exists  it  is  always 
a  fact  for  suspicion  that  something  is  wrong.  Care  must  then 
be  used  to  determine  whether  it  be  due  to  a  faulty  innomina- 
turn,  lumbar  spine,  or  rib. 

Nearly  as  often  there  is  found  an  upward  displace- 
ment of  the  anterior  end  of  the  rib.  This  will  be  noticed 
from  the  narrowed  space  between  the  anterior  end  of  the  rib 
and  the  one  next  above.  In  occasional  cases -the  tip  of  the 
twelfth  seems  to  be  held  by  a  lock  of  some  kind  underneath 
and  behind  the  anterior  part  of  the  eleventh.  We  have  per- 
sonally examined  several  cases  where  we  could  follow  the 
course  of  the  rib  anteriorly  till  it  disappeared  underneath  the 
one  immediately  above.  Just  the  relation  the  tissues  here 
bear  to  each  other  it  seems  impossible  to  determine.  Such 
cases  will  usually  be  quite  obstinate  ones  to  overcome. 

Then  there  are  numerous  cases  where  the  posterior 
end  has  been  displaced  upward  or  downward,  or  the  whole 
rib  has  been  forced  from  its  location.  In  'a  few  it  will  be 
found  luxated  directly  forward  and  situated  so  deeply  in  the 
tissues  as  to  make  its  palpation  quite  difficult. 

Reference  has  been  made  in  most  part  to  the  conditions 
associated  with  the  last  rib.  The  same  considerations  hold 
with  reference  to  the  eleventh  which  is  similar  in  its  formation, 
location,  and  relations.  Occasionally  the  tenth  will  be  also  a 
floating  rib,  since  its  cartilaginous  extension  is  usually  not 
very  perfect  and  often  becomes  broken  loose  from  the  carti- 
lage of  the  ninth.  In  most  of  such  cases  by  movement  of  the 
anterior  end  a  definite  crepitus  may  be  felt  and  sometimes 
heard.  This  seems  to  be  the  friction  between  the  broken 
cartilao-e  and  surface  to  which  it  was  formerly  attached. 


296  PRINCIPLES   OF  OSTEOPATHY. 

v 

ADJUSTMENT  OF  RIBS. 

As  a  general  proposition  covering  the  treatment  of  rib 
lesions  it  may  be  stated  that  the  chest  must  be  considered 
as  a  whole.  Each  rib  is  so  intricately  connected  with  the 
adjacent  one  that  a  considerable  subluxation  of  one  is  alto- 
gether unlikely  unless  associated  with  some  disorder  of  one 
or  more  of  the  others.  This  does  not  mean  that  one  rib  may 
not  be  subluxated  and  the  others  remain  normal.  The  author 
has  seen  numerous  cases  where  no  abnormal  condition  what- 
ever could  be  detected  in  the  ribs  on  either  side  of  the  one  in- 
volved and  yet  the  one  showed  marked  evidence  of  its  per- 
verted condition.  As  a  matter  of  fact  the  larger  number  of 
cases  with  which  the  osteopath  meets  are  those  where  only 
the  slightest  amount  of  actual  displacement  is  present,though 
the  effect  of  such  may  not  be  at  all  slight.  But  it  is  manifest 
that  where  the  ribs  are  normally  so  closely  approximated 
and  are  held  between  two  sheets  of  muscular  and  other  con- 
nective tissue,  a  very  marked  actual  disturbance  of  one  rib 
must  produce  an  appreciable  change  in  the  next.  This  is 
of  practical  value  when  the  application  is  made  to  treat- 
ment. For  the  tension  exerted  on  one  rib  must  be  propagated 
to  the  next.  Hence  in  adjusting  any  one  of  them  an  efficient 
force  can  be  exerted  by  working  upon  another,  preferably 
that  next  to  it.  For  instance  in  an  upward  and  inward  crowd- 
ing of  the  anterior  end  of  the  eleventh,  by  tensing  the  quad- 
ratus  lumborum  and  lower  abdominal  muscles  a  successful 
tension  is  exerted  on  the  eleventh  although  the  principle  ef- 
fect is  upon  the  twelfth.  Similarly,  lifting  the  upper  ribs  will 
assist  very  materially  in  overcoming  a  depressed  condition  of 
those  lower  down. 

Before  beginning  the  treatment  of  any  rib  condition,  es- 
pecially if  it  be  one  involving  several  ribs,  care  must  be  given 
to  determine  whether  the  rib  disorder  is  not  dependent  on  a 
vertebral  disturbance.  For  in  many  cases  the  perverted 
rib  condition  is  normal  to  the  existing  spinal  condition.  Hence 
the  treatment  to  the  ribs  as  a  primary  consideration  is  illogi- 


THORACIC    AND   LUMBAR   LESIONS— COSTAL.  297 

cal  and  will  likely  be  inefficient.  The  condition  and  position 
of  the  ribs  is  far  more  dependent  on  that  of  the  vertebrae  than 
is  the  position  of  the  latter  on  that  of  the  former.  Yet  it  must 
be  noted  that  the  last  named  case  may  be  a  real  one.  A  rib 
disturbed  from  its  normal  position  and  maintained  thus  will 
quite  likely  effect  some  change  in  the  vertebral  relations.  In 
cases  where  the  rib  disorder  is  thus  dependent,  the  logical 
treatment  will  be  directed  to  the  vertebral  disorder.  That 
overcome,  the  ribs  may  adjust  themselves.  Yet  it  is  found 
in  actual  practice  that  treatment  to  both  structures  is  more 
satisfactory  in  point  of  time  and  efficiency  than  that  alone  to 
either  part  and  it  is  entirely  reasonable  that  such  should  be 
true. 

So  far  as  specific  movements  are  concerned  a  few 
only  will  be  mentioned — enough  to  illustrate  the  principles 
which  underlie  practically  all  of  the  manipulations  which  are 
employed.  With  reference  to  the  position  for  treatment  osteo- 
paths differ.  But  either  in  the  erect  or  horizontal  posture 
the  ribs  are  quite  satisfactorily  adjusted.  Any  manipulation 
that  will  pull  the  rib  forward  and  out  from  the  articulations  with 
the  spinal  column  will  be  effective  in  greater  or  less  degree.  In 
most  cases  the  disturbance  will  be  associated  with  the  pos- 
terior part  of  the  rib,  and  that  obstruction  released,  the  an- 
terior part  will  be  self-adjusted.  But  additional  movement 
given  to  the  anterior  part  will  add  to  the  efficiency  of  the 
treatment  in  most  cases.  The  parts  made  use  of  in  adjustment 
are  usually  the  angle  and  the  anterior  end,  the  latter  either 
directly,  as  may  be  done  by  laying  the  flat  of  the  hand  upon 
the  chest  and  exerting  tension  through  sufficiently  close  ap- 
proximation to  prevent  slipping  of  the  tissues,  or  by  acting 
through  the  medium  of  one  or  more  of  the  various  muscles 
which  are  attached  to  the  anterior  and  lateral  aspects  of  the 
ribs.  The  latter  is  perhaps  the  more  common  and  effective 
method.  Exaggeration  of  the  lesion  is  made  use  of  as  in 
most  osseous  disorders.  Hence  if  the  rib  be  depressed  in 
front  and  lifted  behind,  downward  pressure  is  exerted  on  the 


20 


298  PRINCIPLES   OF   OSTEOPATHY. 

anterior  end  and  an  upward  thrust  posteriorly  as  a  prelimi- 
nary to  the  essentially  corrective  treatment.  With  patient  on 
the  left  side,  in  case  of  right  rib  luxation,  the  physician 
stands  in  front  and  with  the  left  hand  reaches  over  to  the 
angle  of  the  rib  where  pressure  may  be  made  in  the  appropri- 
ate direction  to  either  exaggerate  or  adjust.  Then  the  pa- 
tient's right  arm  is  grasped,  drawn  downward  across  the 
chest  and  face,  and  up  over  the  head.  The  movement  should 
be  executed  sloivly.  For  muscle  as  well  as  connective  tissue 
under  normal  conditions  will  yield  to  a  stretching  force  if 
gradually  applied  more  satisfactorily  than  to  the  same  force 
quickly  applied.  In  the  latter  case  the  sudden  motion  will 
act  as  a  stimulus  to  additional  contracture  and  that  condition 
is  already  too  much  in  evidence.  Further,  owing  to  this  lat- 
ter fact,  the  tissue  is  in  an  irritable  condition  and  will  respond 
with  greater  contracture  to  a  lesser  stimulus  than  would  be 
necessary  if  the  tissue  were  normal.  Note  the  reason  for  the 
movement.  The  hand  on  the  angle  of  the  rib  exerts  pressure 
forward  as  well  as  in  a  direction  to  exaggerate  or  adjust. 
This  pulls  the  rib  away  from  its  articulation  sufficient  to  re- 
lease the  deepest  structures  associated  with  the  articulation. 
At  the  same  time  the  same  effect  is  being  produced  by  draw- 
ing the  arm  downward  across  the  chest  and  face  through  the 
mediation  of  the  costo- scapular  muscles.  As  the  arm  is  lifted 
over  the  head  a  direct  upward  traction  is  made  on  the  rib 
through  the  pectoral  and  scapular  muscles  which  powerfully 
loosens  the  structures  associated  with  the  rib.  Then  as  the 
arm  is  freed  but  with  pressure  still  applied  posteriorly,  the  rib 
will  tend  to  settle  back  to  its  normal  relations.  This  is  a  type 
of  a  large  number  of  manipulations  in  common  use  in  which 
practically  the  same  principles  are  made  use  of.  For  instance 
the  same  effects  are  gotten  with  the  physician  standing  be- 
hind instead  of  in  front  of  the  patient  who  is  in  the  lateral 
horizontal  position.  In  this  the  knee  is  sometimes  placed  at 
the  angle  of  the  rib  and  the  free  hand  reaching  over  is  laid 
flat  upon  the  anterior  part  and  in  this  way  additional  force 


THORACIC   AND   LUMBAR   LESIONS— COSTAL.  299 

and  control  may  be  gotten.     Bear  in  mind  the  danger  always 
assooiated  with   the   knee  treatment.     Until  the  student  has 
become  fairly  familiar  with  handling  himself  and  his   patient 
he  should  leave  all  knee  treatments  alone.      Another   method 
in  common  use  and  one  which  is   quite  effective  is  used  with 
the   patient  in  the  dorsal  position.     If  a  left  upper  rib  be  in- 
volved the  physician  stands  at  the  head  and  to  the  left  of   his 
patient.     Then  the  patient's  left  arm  is.placed  between   chest 
and  right  arm  of  the  physician  while  the  right  hand   of  the 
latter  is  passed  beneath  the  cervico- thoracic  junction  to  reach 
the  angle  of  the  rib.     At  the  same  time  the  physician's  other 
hand  may  re-inforce  the  fulcrum  underneath  or  be  employed 
in  direct  work  upon  the  anterior  end  of  the  rib.     In  this  posi- 
tion the  physician,  by  allowing  his  weight  to  be  carried  back- 
ward and  downward  drawing  the  patient's  arm  strongly  with 
it,  may  get  a  very  powerful  and  satisfactory  leverage,  especi- 
ally in  those  conditions  where  there  is  a  generally   depressed 
upper  thoracic  region      The  treatment  is  unsatisfactory  when 
applied  lower  down.     With  the  patient  sitting  the  physician 
stands  in  front   and  reaching   around  underneath  the  axilla 
places  his  fingers  on  the  angle  of  the  rib  distal  to   the   spinal 
column.     With  the  free  hand  the  arm  is  grasped  and    passed 
in   the   usual  manner  over  the  chest  and  face.     Or  standing 
behind,  the  fingers  or  thumb  may  be  used  as  the  fulcrum  while 
the  arm  is  rotated.     For  making  a  fixed  point  at  the  anterior  • 
end  of  the  rib  so  as  to  produce  movement  only  at  the  vertebral  part, 
various  methods  are  employed,  all  based  on  the  same  princi- 
ple as  the  following  one  which  is  made  use  of  quite  common- 
ly by  Dr.  Still.     The  patient  stands   with  chest  against  the 
wall  or  post  which  prevents   material   movement  of   the  an- 
terior end.     Then  making  use  of  the  shoulder  girdle  to  lift  on 
the  rib  through  the  serratus  magnus  and  other  scapular  and  rib 
muscles,  the  posterior  part  of  the  rib  is  forced  and  guided  by 
the  free  hand.     The  same  forces  are  concerned  when  the  pa- 
tient  lies  in  the  ventral  position.     With  an  apparatus,  such 
as  Dr.  Still's    Chair  with  its   sliding  fulcrum,  additional  ad- 


300  PRINCIPLES   OF   OSTEOPATHY. 

vantages  are  gained.  The  patient  sits,  the  fulcrum  rests 
against  the  angles  on  each  side  of  the  spine  and  a  fixed  point 
is  thereby  gained.  Then  with  appropriate  movement  of  arms 
or  body,  standing  in  front  or  behind,  the  ribs  are  quite 
markedly  under  control.  Standing  in  front  the  thumbs  may 
be  inserted  so  as  to  grasp  the  pectoral  muscles  on  either  side. 
Then  by  lifting  and  rotating  the  ribs  may  be  quite  satisfac- 
torily adjusted. 

In  the  case  of  the  first  rib,  owing  to  peculiarities  al- 
ready referred  to,  a  few  new  and  different  factors  must  be 
considered.  It  has  already  been  noted  that  the  upward  sub- 
luxation  is  the  more  common  and  that  it  consisted  in  a  slid- 
ing of  the  rib  at  both  its  transverse  and  central  articulation 
in  an  upward  direction,  owing  in  most  cases  to  the  tension  of 
the  scaleni  muscles.  Naturally  the  treatment  will  be  the  re- 
moval of  the  tension  of  the  scaleni.  Hence  in  all  such  cases 
the  cause  of  the  latter  should  be  sought  and  removed.  Never- 
theless it  is  found  that  in  most  cases  this  will  not  be  sufficient 
since  the  rib  will  have  become  partially  adjusted  to  its  new 
position  and  must  be  directly  worked  upon  for  its  correction. 
A  method  much  employed  consists  in  making  use  of  the 
scaleni  muscles  themselves.  It  is  manifest  that  for  a  down- 
ward displacement  of  the  rib  this  treatment  will  be  entirely 
appropriate,  since  by  flexing  the  head  to  the  opposite  side  a 
direct  upward  traction  can  be  exerted  on  the  muscles  and 
hence  on  the  rib  to  which  they  are  attached.  But  in  the  case 
where  the  rib  is  already  too  high  it  must  be  looked  at  from 
another  standpoint.  The  flexion  of  the  head  is  used  in  the 
same  way  but  this  merely  amounts  to  an  exaggeration  of  the 
lesion.  Thus  as  the  head  is  returned  to  its  normal  erect  posi- 
tion or  passed  on  to  the  side  of  the  luxation,  downward  and  for- 
ward pressure  is  made  upon  the  postero-superior  aspect  of  the 
rib  through  the  muscular  tissues,  and  the  rib  is  thus  lowered 
to  its  normal  situation.  For  acting  upon  the  anterior  end  of 
the  first  rib  the  sterno-mastoid  muscle  may  be  made  use  of 
by  bending  the  head  back  and  to  the  side.  Direct  lifting  of 


LfBFAPY  OF 
COLLEGE  OF  GSTEGT 
FKYSfCr/WS 

THORACIC   AND   LUMBAR  LESIONS — COSTAL.  301 

the  anterior  part  of  the  clavicle  or  an  upward  lift  of  the 
shoulder  girdle  as  a  whole,  will,  through  the  subclavian  mus- 
cle, assist  in  the  manipulation  of  the  rib  through  its  anterior 
extremity.  Note  that  the  anterior  end  can  only  \>e  palpated 
over  a  small  area  since  the  clavicle  covers  all  but  a  small 
portion.  In  case  of  the  posterior  half  of  the  rib  little  difficulty 
will  be  found  in  detecting  the  part.  Reaching  in  front  of  the 
muscular  mass  formed  by  the  trapezius  muscle  as  it  passes 
down  over  the  cervico- thoracic  junction,  the  hand  is  pressed 
gradually  downward  and  backward  and  with  care  the  un- 
yielding rib  tissue  will  soon  be  felt.  The  posterior  border  of 
the  rib  will  usually  be  too  deeply  situated  to  be  readily  de- 
tected unless  it  occupies  an  unusually  high  position. 

The  floating  ribs  require  in  many  cases  different  treat- 
ment from  that  employed  in  correction  of  the  others.  Owing 
to  the  fact  before  referred  to,  that  these  ribs  are  largely  at 
the  mercy  of  the  muscle  tissues  between  which  they  are  sus- 
pended, the  logical  treatment  would  be  directed  toward  pro- 
ducing an  equalization  of  the  tension  of  these  tissues.  It  is 
manifest  that  if  the  rib  be  luxated  downward  because  of  con- 
tracture  of  the  quadratus  lumborum  due  to  a  slipped  innomina- 
tum,  replacing  the  rib  by  work  upon  it  directly,  while  it  may 
be  temporarily  effective,  will  seldom  be  permanently  so.  The 
rational  treatment  would  consist  in  overcoming  the  distorted 
pelvis.  This  further  fact  should  be  noted :  in  very  few  cases 
of  a  downward  subluxation  of  the  twelfth  and  eleventh  ribs, 
will  the  other  lower  ribs  be  in  an  entirely  normal  condition.  In 
most  cases  if  care  be  taken  in  diagnosis  there  will  be  a  gen- 
erally depressed  condition  of  the  lower  part  of  the  chest. 
Hence  the  problem  will  not  be  simply  that  of  reducing  the 
luxated  twelfth  but  the  overcoming  of  the  chest  condition  as 
a  whole.  Even  though  the  other  lower  ribs  be  in  a  normal 
condition  aid  can  be  given  toward  the  adjustment  of  the 
twelfth  by  the  methods  used  to  raise  the  others.  In  case  of 
a  condition  where  the  lower  rib  lies  up  and  under  the  one 
above,  it  is  often  helpful  to  elevate  the  upper  ribs  as  well  as 


302  PRINCIPLES   OF  OSTEOPATHY. 

to  give  direct  treatment  toward  depressing  the  lower.  In  this 
way  a  tendency  toward  separation  of  the  locked  parts  will  be 
produced.  Granting  that  the  treatment  of  the  other  ribs  may 
be  effective  to  a  marked  extent,  it  is  found  that  a  direct  appli- 
cation to  the  rib  involved  is  usually  still  more  so.  This  may 
be  done  in  various  ways.  By  a  torsion  of  the  body  when  the 
patient  lies  on  his  side,  produced  by  exerting  pressure 
forward  on  the  lower  ribs  and  traction  backward  on  the  ilium, 
the  rib.  is  acted  upon  through  the  mediation  of  the  attached 
muscles.  Still  more  direct  effects  may  be  gotten  by  apply- 
ing the  thumb  and  fingers  directly  upon  the  rib.  The  latter 
is  usually  easily  found  and  in  most  cases  spanned  by  the 
thumb  and  fingers.  Then  as  the  arm  is  rotated  to  draw  the 
upper  ribs  away  from  the  lower,  pressure  may  be  exerted  on 
the  latter  in  a  direction  toward  the  normal  situation.  Usually 
the  hand  is  applied  to  the  rib  along  its  course  rather  than  up- 
on the  extreme  anterior  end.  In  most  cases  of  an  abnormal 
condition  of  the  rib  the  tissues  overlying  its  end  will  be  quite 
sensitive  to  pressure  and  hence  any  direct  work  upon  the  ex- 
treme end  is  to  be  condemned.  Especially  any  careless 
"digging"  attempts  should  not  be  made.  In  an  occasional 
case  it  may  be  necessary  and  possible  to  get  the  fingers  in- 
serted somewhat  under  the  anterior  ends  and  an  upward  and 
outward  lift  be  given.  If  so,  great  care  must  be  exercised 
and  time  must  be  taken  to  sufficiently  relax  the  tissues  and 
insinuate  the  fingers  deeply.  In  most  cases  this  treatment 
will  be  entirely  uncalled  for. 

By  making  use  of  the  facts  in  relation  to  the  peculiar 
condition  associated  with  these  lower  ribs  and  applying  the 
generel  rules  of  exaggeration,  rotation,  and  pressure,  the 
student  will  be  able  to  do  effective  work  in  overcoming  rib  le- 
sions in  any  position  of  the  body  and  in  any  condition  of  the 
rib.  The  above  suggested  movements  are  representative  of 
a  large  number  that  may  be  employed  to  advantage. 
STERNUM  AND  CARTILAGES. 

It  is  occasionally  noticed  that  the  sternum  as  a  whole   or 


THORACIC  AND   LUMBAR  LESIONS— COSTAL.  303 

in  part  is  prominent  or  depressed  in  relation  to  the  ribs  and 
their  cartilaginous  terminations.  In  such  cases  we  may  speak 
of  them  as  lesions  in  so  far  as  they  are  producing  additional 
disturbance.  It  must  not  be  supposed  that  such  are  neces- 
sarily primary  disorders.  In  most  cases  a  rib  sublux- 
ation  will  be  responsible  for  the  abnormal  condition  of  the 
sternum.  Note  that  the  only  articulation  of  the  latter  is  with 
the  clavicle  above  and  the  rib  cartilages  laterally.  Hence  it 
is  dependent  upon  these  structures.  Direct  violence  of  course 
may  cause  a  depression,  in  which  case  there  is  likely  to  be  a- 
fractured  cartilage.  Occasionally  the  row  of  cartilages  on- 
one  side  will  be  more  prominent  than  that  of  the  opposite- 
side.  ^hQ  junction  between  the  rib  and  cartilage  is  not  a 
typical  articulation  and  permits  of  no  appreciable  move- 
ment. Quite  often  movement  will  be  noticed  but  it  will 
be  found  to  be  a  fracture.  A  bending  at  the  costo-chondral 
junction  takes  place  to  a  greater  or  less  extent  during  the 
respiratory  actions,  but  not  a  gliding  movement. 

The  fact  should  be  remembered  that  the  sternum  consists 
of  three  parts  more  or  less  independent— parts  which  may  be 
made  to  appear  more  distinct  by  lesion  conditions.  The 
ensiform  is  occasionally  abnormal,  either  lateral,  anterior,  or 
posterior.  In  such  the  fault  is  a  nutritive  one  in  which  the 
part  has  grown  into  its  abnormal  position.  The  junction  of  the 
gladiolus  and  manubrium  should  be  noted.  This  is  usually 
easily  detected  from  its  greater  prominence  and  from  the  fact 
that  the  junction  between  these  is  the  landmark  for  the  sec- 
ond rib.  In  "pigeon  breast"  this  junction  is  quite  angular, 
though  the  union  is  efficient  and  will  permit  of  little  if  any 
movement. 

The  treatment  for  such  irregularities  is  directed  to  the 
adjustment  of  the  ribs  and  to  a  gradual  pressure  applied  fre- 
quently to  the  prominent  parts  of  the  cartilage  structures. 
Where  the  rib  has  been  broken  from  its  cartilage,  as  is  fre- 
quently the  case  with  the  tenth,  little  likelihood  of  union  is 
present.  Cartilage  is  an  inert  structure  and  unless  perfect  ap- 


304  PRINCIPLES   OF   OSTEOPATHY. 

proximation  be  maintained  no  union  is  probable.  Fortunately 
the  failure  to  unite  does  not  seem  to  present  great  disadvan- 
tage, although  in  occasional  cases  a  continued  sensory  irrita- 
tion will  be  a  source  of  annoyance.  In  a  few  cases  exquisite 
pain  will  be  brought  out  on  pressure  over  the  part.  This  is 
true  also  of  cases  where  the  cartilage  has  seemingly  been 
wrenched.  Usually  a  freeing  treatment  in  connection  with 
the  rib  as  well  as  the  part  immediately  involved  will  be  effi- 
cient. 

THE  CLAVICLE. 

The  clavicle  is  a  structure  which  is  occasionally  found  in 
a  disordered  condition.  Numerous  slight  subluxations 
occur  either  as  a  result  of  direct  violence  or  as  a  result  of  in- 
equality in  the  tension  exerted  by  the  attached  muscles.  The 
same  possibilities  for  lesion  are  present  in  the  clavicular  ar- 
ticulations as  exist  in  reference  to  other  osseous  structures 
which  present  definite  articulating  surfaces.  Complete  disloca- 
tion of  the  clavicle  is  common  enough  in  surgical  practice  and 
presents  its  typical  symptoms.  It  is  not  with  such  a  condi- 
tion that  this  work  deals,  as  that  is  sufficiently  emphasized  in 
the  works  on  surgery.  But  the  large  number  of  patients  who 
present  themselves  complaining  of  various  pain  and  other 
symptoms  seemingly  related  to  the  clavicular  structures  makes 
it  necessary  for  the  osteopath  to  examine  carefully  into  such. 
A  surprisingly  large  number  of  slight  and  serious  disorders 
have  been  absolutely  cured  by  overcoming  some  hardly  ap- 
preciable disorder  of  one  or  both  articulations  of  the  clavicle. 
The  following  typical  case  illustrates  the  conditions  met  with : 
a  young  man  in  lifting  the  corner  of  a  wagon  box  over  his 
shoulder,  permitted  it  to  fall,  striking  him  near  the  acromio- 
clavicular  junction.  For  a  few  days  thereafter  some  soreness 
of  the  tissues  and  pain  on  movement  of  the  arm  was  manifest 
but  within  a  few  weeks  no  disturbance  was  noted.  Shortly, 
however,  interference  with  the  free  movement  of  the  shoulder 
was  noticed.  Pain  was  felt  on  lifting  the  arm  while  weakness 


THORACIC  AND   LUMBAR  LESIONS — COSTAL.  305 

of  the  latter  became  apparent.  On  presenting  himself  to  the 
physician  some  two  months  after  the  accident  a  diagnosis  of 
downward  subluxation  of  the  acromial  end  of  the  clavicle  was 
made  and  treatment  given  accordingly.  The  actual  change 
in  position  of  the  part  was  almost  inappreciable  though  there 
was  much  tenderness  and  some  contracture  in  close  relation 
to  the  articulation.  The  only  treatment  given  consisted  in 
separating  the  two  articulations  and  a  lifting  upward  of  the 
clavicle.  Two  such  were  given  resulting  in  a  complete  and 
rapid  recovery  of  normal  conditions.  This  case  is  typical  of 
a  large  number  of  very  slight  subluxations  which,  as  in  the 
one  described,  are  produced  by  traumatism  or,  as  in  numer- 
ous others, results  from  a  disturbed  equilibrium  of  the  muscle 
tension.  Such  cases  are  very  common  in  practice  and  are 
among  the  most  satisfactory  to  practitioner  and  patient  alike. 
The  treatment  for  clavicular  lesions  is  usually  a  matter 
of  no  great  difficulty.  Naturally,  if  the  disorder  be  due  to 
some  fault  in  the  musculature  of  the  bone,  the  nerve  supply 
for  such  must  be  investigated.  In  a  few  such,  overcoming 
the  muscle  disorder  will  be  all  that  is  necessary  but  in  most  a 
direct  application  to  the  part  is  helpful  if  not  essential.  Any 
method  which  tends  to  increase  the  distance  between  acromion  and 
sternum  will  be  helpful.  The  function  of  the  clavicle  is  in 
part  to  form  a  brace  for  the  shoulder  girdle,  and  hence  nor- 
mally there  is  a  continued  pressure  exerted  at  either  articu- 
lation. Separation  of  the  two  parts  will  therefore  be  advan- 
tageous in  lessening  the  points  of  contact  and  thereby  per- 
mitting muscular  tension  as  well  as  the  direct  work  of  the 
physician  to  re- adjust  the  disturbed  relations.  In  order  to 
directly  grasp  the  clavicle  the  physician  may  stand  behind  the 
patient  who  sits  on  a  stool.  If  the  left  clavicle  be  involved, 
the  right  hand  is  passed  in  front  of  the  patient  the  thumb  is 
placed  in  the  supra-clavicular  fossa.  Then  with  the  left  hand 
the  operator  lifts  the  shoulder  girdle  in  a  direction  upward  and 
forward  by  means  of  the  elbow  of  the  patient.  This  relaxes 
the  tissues  associated  with  the  clavicle  and  allows  the  thumb 


306  PRINCIPLES    OF   OSTEOPATHY. 

to  sink  in  behind  the  bone,  after  which  the  part  may  be 
grasped  between  thumb  and  fingers.  Then  by  drawing  the 
arm  back  the  articular  structures  are  separated,  and  the 
clavicle  can  be  guided  into  its  normal  situation.  In  inserting 
the  thumb  behind  the  clavicle  care  must  be  exercised  or  ex- 
quisite pain  may  he  caused.  By  lifting  the  shoulder  girdle  and 
in  that  way  raising  the  clavicle  in  front  of  the  thumb  which  is  held 
stationary,  less  pain  and  greater  effeciency  will  result  than  by 
forcing  the  thumb  down  behind  the  part.  This  same  treat- 
ment, so  far  as  principles  are  concerned,  may  be  used  with 
the  patient  in  the  dorsal  position.  In  this  case  the  fingers 
rather  than  the  thumb  are  used  to  insert  under  the  clavicle. 
For  purposes  of  separation  of  the  articular  structures  a  good 
method  consists  in  placing  the  knee  in  the  back  between  the 
shoulders;  then  with  hands  on  the  latter  they  are  pulled  di- 
rectly backward.  The  freeing  of  the  articular  surfaces  and 
lessening  of  tension  of  associated  tissue  resulting  will  often 
be  sufficient  to  overcome  slight  lesion  of  either  or  both  ends 
of  the  bone. 

THE  SCAPULA. 

The  scapula  is  never  luxated  in  the  usual  sense  of  that  word 
since  the  only  articulation  it  presents  is  with  the  acromial  end 
of  the  clavicle  and  with  the  head  of  the  humerus.  But  in  oc- 
casional cases  there  is  noted  a  change  in  position  of  the 
scapula  which  may  be  quite  marked.  The  scapula,  like  the 
hyoid  bone,  is  merely  suspended  between  muscular  and  liga- 
mentous  structures,  and  hence  any  disorder  in  position  that 
it  presents  merely  indicates  that  a  disturbance  in  the  equilib- 
rium of  muscular  tension  exists,  due  to  a  weakness  of  one 
muscle  or  set  of  muscles  or  an  undue  tonic  condition  of 
others.  The  condition  referred  to  as  winged  scapula  is  a  typi- 
cal case  of  this  kind.  In  such  the  latissimus  dorsi  which 
crosses  the  inferior  angle,  and  other  muscles  which  attach  to 
the  posterior  margin  of  the  scapula  are  in  a  condition  of  loss 
of  tone.  This  permits  the  more  anterior  and  unopposed  mus- 
cles to  draw  the  part  forward  and  cause  the  marked  projec- 


THORACIC   AND   LUMBAR  LESIONS — COSTAL.  307 

tion  of  the  angle  which  is  characteristic.  Tn  other  cases  the 
scapula  will  be  seen  to  occupy  a  position  too  closely  approxi- 
mated  to  the  spinal  column.  This  always  suggests  an  irrita- 
tion to  the  rhomboids  and  posterior  fibres  of  the  serratus 
magnus.  Normally  there  is  a  space  equal  to  a  hand's  breadth 
between  the  vertebral  edges  of  the  two  scapulae.  This  fact 
will  enable  the  student  to  determine  a  probable  displacement. 
Caution  must  be  used  since  the  distance  varies  within  wide 
limits. 

The  treatment  for  the  displaced  scapula  will  depend 
on  finding  and  removing  the  irritation  that  keeps  up  the  un- 
due contracture  or  that  has  exhausted  the  tissue  in  its  atonic 
condition.  The  student  should  be  able  to  determine  from  his 
knowledge  of  the  musculature  the  appropriate  methods  of 
directly  relaxing  the  tissue,  and  from  his  knowledge  of  nerve 
origin  the  lesions  likely  to  be  responsible  for  the  irritation. 


308  PRINCIPLES   OF   OSTEOPATHY. 


CHAPTER  XV. 


THORACIC  AND  LUMBAR  LESIONS— EFFECTS. 
DIRECT  PRESSURE. 

Disorders  resulting  from  direct  pressure  of  the  spine  up- 
on the  organs  are  not  common,  since  it  is  only  an  extreme 
anterior  condition  that  would  sufficiently  crowd  the  structures 
to  produce  disorder.  But  in  many  cases  associated  with  a 
flattened  chest  the  flat  upper  thoracic  spine  may  interfere 
directly  with  the  activity  of  various  of  the  thoracic  viscera. 
In  the  lumbar  portion  the  spine  is  occasionally  so  noticeably 
anterior  as  to  be  easily  palpated  from  the  ventral  aspect.  Such 
may,  in  a  way,  produce  effects  by  direct  pressure. 
VASCULAR  OBSTRUCTION. 

Interference  with  vessels  is  largely  limited  to  the  branches 
associated  with  the  spinal  column  belonging  to  the  inter- 
vertebral  system.  The  arteries  given  off  from  the  inter- 
costals  pass  directly  back  to  supply  in  part  the  spinal  canal 
structures  through  the  intervertebral  openings,  and  in  part 
the  muscles  and  superficial  tissues  on  the  dorsal  aspect.  Le- 
sions of  the  vertebrae  or  deep  ligamentous  structures  may, 
therefore,  cause  a  lessening  of  the  nutritive  supply  of  the 
spinal  cord,  which  will  produce  any  form  and  number  of  ef- 
fects dependent  on  interference  with  the  nerve  impulses  pass- 
ing from  the  particular  spinal  segment  involved.  These  ef- 
fects will  be  discussed  more  in  detail  in  a  succeeding  section. 
In  the  same  way  the  venous  drainage  being  impaired,  the 
venous  congestion  resulting  will  seriously  impair  the  nerve 
discharge.  The  muscle  contracture  by  interfering  with  the 
normal  flow  through  the  softer  tissues  of  the  spine  may  not 
only  cause  disorder  of  their  own  nutrition  but  collaterally  pro- 
duce disorder  of  the  next  immediate  branches,  i.  e.,  those  pass- 


THORACIC   AND   LUMBAR   LESIONS— EFFECTS.  309 

ing  to  the  cord,  if  the  condition  is  maintained  sufficiently  long. 
In  the  lumbar  part  of  the  spine  the  lumbar  vessels  passing 
in  close  relation  to  the  psoas  muscle  may  be  interfered  with  by 
abnormal  conditions  of  that  structure,  in  addition  to  crowding 
of  the  branches  that  lie  in  their  relation  to  the  spine  similar 
to  those  in  the  thoracic  portion.  In  the  upper  thoracic  re- 
gion the  closeness  of  the  upper  thoracic  spine  to  the  sternum 
and  anterior  part  of  the  clavicle  and  first  rib  may  more  or  less 
seriously  obstruct  the  flow  through  the  large  vessels  in  that 
region.  These  are  more  properly  discussed  in  connection 
with  the  rib  lesions  because  it  is  usually  the  rib  structures 
which  are  mostly  at  fault. 

SPINAL  NERVES. 

The  nerves  likely  to  be  involved  from  lesion  of  the  spine 
in  the  thoracic  and  lumbar  portions  are  the  same  in  kind  as 
those  in  the  cervical  portion  except  that  the  cranial  system 
will  not  be  involved.  Of  the  spinal  nerves  proper  the  twelve 
thoracic  and  five  lumbar  are  situated  in  positions  where 
marked  luxation  may  produce  irritation.  The  anterior  branch 
of  the  first  thoracic  nerve  aids  in  formation  of  the  brachial 
plexus,  that  of  the  second  sends  an  offset  to  supply  the  cutan- 
eous tissues  of  the  arm,  while  from  the  last  a  branch  is  sent  to 
the  tissues  overlying  the  hip.  With  these  exceptions  the  an- 
terior branches  are  continued  over  the  chest  and  abdomen  as 
the  intercostal  nerves.  So  far  as  the  spine  is  concerned  these 
nerves  will  only  be  impinged  at  the  intervertebral  regions. 
The  effects  from  such  are  varied  in  number  and  intensity. 
Intercostal  neuralgias  are  common.  These  suggest  purely  an 
interference  with  the  afferent  spinal  fibres.  If  a  pair  of 
nerves  be  involved  it  indicates  a 'tmore  central  disorder,  i.  e., 
involvement  of  the  segment  of  the  cord  with  which  the  nerve 
is  connected.  If  a  single  side  be  disturbed  it  is  more  likely 
interference  with  the  nerve  or  its  ganglion  cell  body  on  the 
one  side  of  the  spine.  Other  disorders  of  sensation  may  be 
present.  The  motor  organs  may  be  involved.  Tightenings 


310  PRINCIPLES   OF   OSTEOPATHY. 

of  the  chest  wall  or  of  the  abdominal  parieties,  either  tonic  or 
spasmodic  may  occur,  while  the  atonic  condition  of  the  ab- 
dominal walls  is  a  fairly  common  disorder.  These  spinal 
nerves, through  their  connection  with  the  thoracic  and  lumbar 
sympathetic  systems,  carry  fibres  subserving  the  various 
functions  associated  with  the  latter  system  and  will  be  spoken 
of  later.  It  must  further  be  noted  that  there  is  possibility  of 
disorder  of  the  thoracic  viscera  from  involvement  of  the  in- 
tercostals.  This  is  true  not  only  because  of  the  disturbance 
of  the  action  and  condition  of  the  chest  wall,  or  through  the 
reflex  mechanism,  but  by  virtue  of  the  fact  that  the  ter- 
minals of  the  nerves  have  been  traced  across  the  space  be- 
tween the  wall  and  the  pleura;  and  into  the  latter  structures. 
Hence  pleuritic  disorders  may  be  partly  dependent  on  spinal 
nerve  irritation.  The  posterior  branches  of  the  thoracic  and 
lumbar  spinal  nerves  are  distributed  to  the  dorsal  structures 
both  superficial  and  deep.  Irritation  to  them  will  produce 
muscular  contracture,  sensory  disorders,  and  disturbance  of 
associated  sympathetic  functioning.  The  "stitch"  in  the 
back,  lumbago  attacks,  and  many  so-called  kidney  pains  are 
in  most  cases  disorders  of  the  sensory  nerves  in  these  regions 
dependent  on  vertebral  lesion  or  muscle  contracture.  Simi- 
larly those  structures  of  the  limbs  supplied  from  the  posterior 
branches  of  the  lumbar  nerves,  which  include  the  superficial 
tissues  of  the  buttocks  and  upper  thigh,  may  be  involved  in 
numerous  forms  of  disorder. 

With  respect  to  the  anterior  divisions  of  the  lumbar 
nerves  numerous  facts  must  be  borne  in  mind.  These  branches 
passing  from  the  foramina  with  the  exception  of  the  fifth  enter 
the  psoas  muscle  to  form  the  lumbar  plexus.  This  muscle 
lies  in  front  of  and  is  attached  to  the  transverse  processes  of 
the  lumbar  vertebrae.  In  this  situation,  therefore,  we  find  a 
very  reasonable  possibility  for  irritation,  not  only  from  dis- 
torted conditions  of  the  vertebras' themselves  thus  initiating 
muscle  contracture  or  directly  affecting  the  nerves,  but  from 
contraction  of  that  muscle  from  other  causes  the  plexus  may 


THORACIC   AND   LUMBAR   LESIONS — EFFECTS.  311 

be  disordered  in  all  or  any  of  its  parts. 

The  sacral  plexus  is  in  part  formed  from  the  fourth  and 
fifth  lumbar  nerves.  This  plexus  lies  upon  the  pyriformis 
muscle  and  enters  into  the  great  sacro- sciatic  foramen  where 
it  continues  as  thegreat  sciatic  and/>«</zV nerves  to  be  distribut- 
ed to  the  limb  and  various  of  the  pelvic  structures. 

In  discussing  the  effects  of  lumbar  lesions  it  is  advisable 
to  mention  a  few  of  the  more  important  nerve  trunks 
having  their  origin  in  the  lumbar  portion  of  the  spinal  cord, 
and  trace  in  brief  various  of  the  more  common  disorders  with 
which  the  practitioner  comes  in  contact.  One  set  of  fibres 
from  the  lumbar  plexus  passes  to  supply  the  lower  abdominal 
and  genital  areas  and  to  some  of  the  structures  on  the  anterior 
aspect  of  the  upper  thigh.  Contractures  of  the  psoas  muscle 
or  lesions  of  the  lumbar  region  may  therefore  cause  various 
curvatures  and  muscular  disorders.  Another  set  pass  to  be 
distributed  to  the  antero-internal  areas  of  the  thigh.  Among 
these  are  several  of  special  importance.  The  external  cutaneous 
passes  anteriorly  and  externally  to  supply  the  skin  and  other 
cutaneous  structures  as  far  as  the  knee.  The  obturator  is  of 
special  importance  inasmuch  as  it  often  by  pain  conditions 
suggests  hip  or  other  lesions.  It  is  cutaneous,  muscular,  and 
articular  in  its  distribution,  supplying  both  hip  and  knee 
joint  and  various  of  the  structures  between.  The  anterior 
crural,  the  largest  of  the  more  anterior  nerves,  is  distributed 
to  the  antero-internal  aspect  of  the  thigh  and  in  addition 
sends  a  few  filaments  down  the  leg  and  foot.  It  supplies 
cutaneous,  muscular,  vascular,  articular,  and  osseous  tissues. 
Numerous  forms  and  intensities  of  disorders  may  therefore 
arise  from  a  lesion  in  the  region  of  the  lumbar  spine  or  other 
part  in  connection  with  this  nerve.  In  many  cases  a  severe 
neuritis  similar  to  involvement  of  the  sciatic  nerve  is  asso- 
ciated with  the  anterior  crural.  Disturbances  of  the  knee  or 
hip  to  which  it  sends  articular  branches  are  common.  Dis- 
orders of  the  sciatic  nerve  may  result  from  the  lumbar  lesion, 
since  the  lumbar  nerves  are  concerned  in  the  formation  of  the 


312  PRINCIPLES    OF   OSTEOPATHY. 

sacral  plexus.  One  of  the  most  common  causes  of  sciatica  is 
a  disordered  condition  of  the  lumbar  spine.  Since  the  sciatic 
nerve  supplies  the  remainder  of  the  thigh  and  leg  not  before 
mentioned,  the  possibility  of  a  large  number  and  variety  of 
effects  from  lesion  affecting  its  origin  is  obvious. 

In  case  of  all  these  spinal  nerves  described  it  must  be 
constantly  borne  in  mind  that  they  carry  in  addition  to  fibres 
properly  of  a  spinal  origin,  others  derived  from  the  sympa- 
thetic ganglia.  Hence  various  of  the  sympathetic  func- 
tions will  be  interferred  with  in  lesion  to  the  nerve. 

SYMPATHETIC  NERVES. 

The  division  of  the  sympathetic  system  which  is  associ- 
ated with  the  thoracic  part  of  the  spine  is  of  importance  from 
the  fact  that  it  comprehends  the  area  ofey.it  of  the  white  rami  com- 
municantes,  and  in  large  part,  which  is  principally  dependent 
upon  the  former  fact,  comprises  the  area  from  which  efferent 
impulses  pass  from  the  central  system.  We  have  already 
discussed  the  various  functions  of  the  sympathetic  filaments 
distributed  from  the  cervical  ganglia.  It  remains  to  show 
that  in  large  part  the  impulses  distributed  front  these  cervical  gan- 
glia are  dependent  upon  other  impulses  received  from  the  spinal  cord 
through  the  mediation  of  the  thoracic  ganglia.  For  instance  fair- 
ly good  evidence  is  presented  to  show  that  the  pupillo-dilator 
fibres  that  ascend  from  the  superior  cervical  ganglion  leave 
the  spinal  cord  by  the  white  rami  in  the  upper  thoracic  region. 
Similarly  though  not  so  noticeably  it  is  true  of  the  constrictor 
fibres.  The  vaso-motor  fibres  that  pass  with  the  carotid  and 
cavernous  plexuses  to  reach  the  eye,  the  ear,  and  the  men- 
inges  of  the  brain,  leave  the  cord  in  the  thoracic  region.  It 
is  known  that  the  cardiac  accelerators  that  are  given  off  from 
the  cervical  ganglia  by  the  cardiac  nerves  all  issue  from  the 
thoracic  cord  in  the  upper  two  or  three  of  its  segments.  The 
vaso-motor  fibres  that  supply  the  vertebral,  subclavian,  thy- 
roid, and  other  cervical  vessels  are  also  derived  from  this  re- 
gion. Hence  the  general  statement  is  not  far  wrong  that  any 


THORACIC  AND  LUMBAR  LESIONS — EFFECTS. 


313 


disorder  produced  by  a  cervical  lesion  may  be  duplicated  by   an  up- 
per thoracic  disturbance. 

In   addition   to  the  effects  upon   the  fibres  that  are  dis- 

t  ributed  by 
way  of  the 
c  e  r  v  i  cal 
sympathetic, 
however, 
there  are 
nu  m  er o  us 
additi  o  n  al 
effects  from 
the  up  per 
thoracic  le- 
si  o  n.  The 
heart  and 
aorta  may 
be  involved. 
There  al- 
ready has 
been  sug- 
gested a  way 
in  which  the 
heart  may 
be  disorder- 
ed throu  g  h 
disturbances 
of  the  ac- 
cel e  ra  tor 
ne  r  v  e  on 
the  one  hand 
These  fibres  pass 


V-D 


Fig.   26. — Nerve  mechanism  of  the  heart. 

or  of  the  cardiac  vaso-motors  on  the  other, 
out  of  the  upper  thoracic  segments  and  in  large  part'are  car- 
ried to  the  cervical  ganglia  from  whence  they  are  distributed 
to  the  cardiac  plexus \  Some  few  fibres  may  pass  directly  from 

the  upper   thoracic  ganglia  and  join  with  that  plexus.     It  is 

21 


314  PRINCIPLES   OF   OSTEOPATHY. 

known  that  fibres  passing  from  these  upper  ganglia  make  a 
direct  connection  with  the  thoracic  aortic  plexus  in  close  associa- 
tion with  the  heart.  It  is  reasonable  to  assume  though  per- 
haps difficult  to  demonstrate  that  these  fibres  have  a  vaso- 
motor  function  in  connection  with  the  thoracic  aorta.  This 
is  interesting  as  throwing  light  on  the  recoil  of  the  aorta 
following  each  systole  of  the  ventricle,  for  according  to  Hun- 
ter and  others  the  force  of  the  recoil  is  greater  than  the  force 
necessary  to  cause  the  distension  in  the  first  place.  Disturb- 
ances of  this  condition  of  the  aortic  tone  may  quite  materially 
produce  disturbances  of  the  heart's  action.  The  cardiac  dis- 
turbance resulting  from  the  very  common  upper  thoracic  le- 
sion is  more  likely  dependent  upon  the  cardiac  accelerators 
that  pass  out  from  the  cord  in  this  region  and  upon  the  coro- 
nary vaso- motors  that  probably  do  so.  A  lesion  acting]as  a 
stimulus  to  these  fibres  or  their  cell  bodies  in'the  cord  will  in 
the  first  place  produce  increased  tone  of  the  cardiac  and  ar- 
terial muscle,  but  if  kept  up  sufficiently  long,  which  is  true 
of  most  lesions,  an  exhausted  condition  will  result  which 
-amounts  to  inhibition  and  this  ultimately  means  a  failing 
heart.  The  upper  three  or  four  segments  of  the  spinal  cord 
represent  then  the  typical  cardiac  area  of  the  cental  nervous 
system  and  the  typical  region  for  spinal  lesions  affecting  the 
heart. 

This  same  region  is  one  common  to  lesions  affecting  the 
arm  and  may  be  spoken  of  as  the  vaso-motor  center  for  the 
arm.  The  sympathetic  fibres  reach  the  tissues  of  the  arm  by 
at  least  two  pathways.  The  fibre  passing  out  by  way  of  the 
white  ramus  is  conducted  from  the  thoracic  ganglion  up- 
ward into  the  inferior  cervical  ganglion  from  whence  the 
nerve  impulse  is  carried  by  the  grey  fibre  into  the  [cer- 
vical nerves  forming  the  brachial  pelxus  and  is  distributed 
with  those  fibres  to  the  arm.  Or  instead  of  passing  from  the 
inferior  cervical  ganglion  to  connect  with  the  spinal  nerves, 
fibres  are  given  off  directly  from  the  ganglion  to  form  the 
plexus  distributed  to  the  subclavian  artery  and  its  continuation. 


THORACIC   AND   LUMBAR  LESIONS — EFFECTS. 


315 


Hence  it  is  possible  that  either  of  these  two   courses    may  be 

I  the  pathway  for  disturbed 
vaso- motor  impulses  to  the 
upper  limb.  Cases  are  on 
record  where  a  lesion  as  low 
0  as  the  fifth  or  sixth  was  di- 
rectly responsible  for  dis- 
turbance in  the  arm.  In 
such  case  the  presumption 
is  that  the  fibres  constitut- 
ing the  vaso -motor  mechan- 
ism originated  in  the  cord 

FIG.  27.— Showing  double  pathway    for   at     this    level.       Usually    the 
synthetic  nerve  fibres  to  the  arrn.        legk)n     wjU    be     congiderably 

higher.  Various  kinds  of  effects  will  be  noticed  in  connection 
with  such  lesion.  Superficial  disturbances,  such  as  eczema 
and  other  eruptions ;  sensory  disorders  in  the  way  of  definite 
pain  sensations,  or  tinglings  and  numbness;  or  deeper  dis- 
orders may  be  present,  such  as  malnutrition  of  the  muscles 
and  other  tissues,  congestion  and  inflammation. 

The  upper  portion  of  the  thoracic  spine  is  also  a  typical 
region  for  pulmonary  disorders.  The  area  from  the 
second  to  the  seventh  thoracic  is  the  vaso- motor  center  for 
the  lung  and  its  associated  structures.  That  is,  from  this 
region  white  fibres  leave  the  cord  ultimately  to  carry  impulses 
to  the  muscle  fibres  in  the  pulmonary  arterioles.  These  fibres 
are  not  as  numerous  as  are  those  to  some  other  of  the  viscera 
but  are  fairly  easy  of  detection.  They  pass  directly  from  the 
upper  thoracic  ganglia  to  reach  the  pulmonary  plexuses  which 
are  made  up  by  them  with  additional  fibres  received  from  the 
cardiac  plexus  and  numerous  filaments  derived  from  the  vagus. 
These  direct  fibres  carry  vaso-motor  impulses  to  the  lung  ves- 
sels and  sensory  impulses  from  the  tissues  back  to  the  cord.  It 
has  long  been  known  that  there  are  tender  areas  posteriorly 
between  the  shoulders  in  many  diseases  of  the  lungs  and  this 
fact  of  the  sensory  distribution  helps  to  explain  that  condition. 


316 


PRINCIPLES   OF   OSTEOPATHY. 


Various  congestive  and  inflammatory  conditions  of  the  lung 
tissues  will  result  from  lesion  in  this  spinal  area.  Bronchitis 
following  exposure  of  some  kind  depends  upon  irritation  to 
vaso- motor  distribution  in  the  bronchial  mucosa;  congestion 
of  the  lungs  both  simple  and  where  complicated  by  pneumo- 
nia are  dependent  on  similar  disorder;  pleurisy  and  affections 

of  the  more  superficial  parts  of 
-  the  chest  wall  are  similarly 
caused;  asthma  has  its  usual 
lesion  in  the  thoracic  spine  and 
the  ribs,  while  other  disorders 
I  D  of  the  respiratory  mechanism 
too  numerous  to  detail  are  con- 
tinually met  with,  and  in  large 
"  part  depend  on  irregularities 
in  the  spinal  areas  concened. 
~  ,^  Not  only  these  efferent  nerves 
may  thus  cause  disorder  but 
afferent  filaments  leading  from 
the  lung  and  chest  regions  may 
be  sufficiently  irritated  to  produce  disorder.  For  it  has  been 
shown  that  the  respiratory  center  in  the  medulla  is  easily  af- 
fected by  stimuli  from  the  sensory  fibres  contained  in  the 
intercostals.  Every  one  has  experienced  the  spasmodic  effect 
produced  on  the  respiratory  apparatus  by  a  sudden  cooling  of 
the  cutaneous  tissues  of  the  chest  region,  and  ail  obstetricians 
know  that  a  smart  blow  on  the  cutaneous  tissues  will  tend  to 
initiate  the  automatic  action  of  the  respiratory  center  in  the 
case  of  a  newborn  child  when  simple  exposure  to  the  air  is 
not  a  sufficient  stimulus.  Hence  it  is  not  unreasonable  to 
assume  that  an  increased  number  of  afferent  impulses  from 
this  region  dependent  on  chronic  muscle  contracture  or  other 
lesion  may  be  an  efficient  factor  in  causing  a  disturbance  of 
the  respiratory  rhythm  and  hence  producing  greater  liability 
to  other  influences  of  a  deleterious  character. 

The   middle   and  lower  part  of  the  thoracic  spine  is  a  re- 


FIG.  28. — Sympathetic    Inuervation 
of  lung. 


THORACIC   AND   LUMBAR   LESIONS — EFFECTS. 


317 


gion  of  importance  since  it  represents  that  part  of  the  cord 
and  sympathetic  system  which  is  in  direct  control  of  the  di- 
gestive processes.  From  the  thoracic  ganglia  including  the 
fourth  to  the  tenth  are  given  off  efferentes  which  makeup  the 
greater  or  lesser  splanchnic  nerves  whose  importance  to  the 


Fig.  29. — Sympathetic  nerve  supply  of  abdomen. 

physician  all  osteopaths  recognize.  The  least  splanchnic  is 
more  concerned  with  other  than  the  digestive  functions 
and  hence  is  not  considered  in  this  connection.  It  is  unsafe 


318  PRINCIPLES   OP   OSTEOPATHY. 

to  put  any  absolute  limits  to  the  splanchnic  area  since  both 
physiological  experimentation  on  the  lower  animals  and  os- 
teopathic  experience  in  connection  with  human  diseases  show 
that  the  area  varies  within  very  wide  limits.  For  instance  lesions 
as  high  as  the  second  thoracic  and  as  low  as  the  tenth  have 
been  known  to  cause  stomach  disorder.  Whether  such  indi- 
cates that  the  splanchnic  filaments  passing  to  the  stomach  in 
these  cases  issued  from  the  cord  in  these  regions  of  course  is 
not  proven,  but  the  assumption  is  not  unreasonable.  The 
fibres  that  pass  by  way  of  the  splanchnic  nerve  and'  solar 
plexus  to  reach  the  stomach  are  concerned  with  numerous 
functions.  It  is  known  that  sensory  fibres  subserving  the  pur- 
pose of  pain  pass  by  this  route  to  reach  the  spinal  cord 
and  ultimately  the  sensorium.  Disturbance  of  these  fibres 
from  spinal  lesion  may  create  not  unly  sensory  reflexes  but 
by  increasing  the  impulses  to  the  cord  segments  create  local 
metabolic  disorder  which  will  result  in  excess  of  outgoing  im- 
pulses to  the  stomach.  These  fibres  contain  numerous  forms 
of  efferent  nerves.  The  vaso-motors,  both  constrictor  and  dila- 
tor, pass  to  the  gastric  arterioles.  One  of  the  most  common 
of  stomach  disorders  is  a  temporary  congestion  or  inflamma- 
tion (gastritis)  of  the  mucosa.  This  is  readily  produced  by 
lesion  affecting  the  vaso-motors.  A  sour  stomach  is  a  common 
disorder.  It  is  usually  dependent,  not  on  an  excess  of  the 
normal  acid  of  the  stomach,  i.  e.,  hydrochloric,  but  upon  a 
fermentation  process  with  liberation  of  lactic  and  other  or- 
ganic acids  from  changes  in  the  foods  present.  It  is  not 
sufficient*  to  reply  that  this  fermentation  is  due  to  the  presence 
of  various  forms  of  micro-organisms.  The  normal  condition 
of  the  stomach  precludes  any  activity  of  such  bacteria  as  are 
not  beneficial  to  the  body.  An  ill- nourished  condition  of  the 
stomach  dependent  on  a  deficient  nutrient  supply  is  present, 
and  is  usually  dependent  on  interference  with  these  nerves. 
The  same  interference  may  result  in  excessive,  deficient,  or 
changed  secretions,  since  one  of  the  important  controlling 
factors  in  secretion  is  the  blood  supply.  Whether  there  are 


THORACIC   AND   LUMBAR   LESIONS — EFFECTS.  319 

any  proper  secretory  fibres  to  the  gastric  glands  through  the  sym- 
pathetic system  remains  yet  to  be  satisfactorily  demonstrated. 
There  is  quite  good  evidence  that  the  pneumogastric  fila- 
ments exercise  such  a  direct  control  and  it  is  not  unreason- 
able to  assume  that  the  sympathetic  by  disturbance  of  the 
other  conditions  may  likewise  interfere  with  the  normal  secre- 
tory activity  of  the  vagus.  Further  the  general  statement  is 
made  that  the  sympathetic  carries  viscera-inhibitors  to  the  ali- 
mentary tract  including  the  stomach,  while  the  vagus  carries 
the  viscero- motors.  This  is  undoubtedly  true  in  so  far  as  the 
most  marked  action  is  concernned,  i.  e.,  the  usual  result  of 
experimental  stimulation  of  the  peripheral  end  of  the  cut 
sympathetic  is  an  atonic  condition  of  the  muscle  tissue  in  the 
gastric  walls.  Hence  a  lesion  acting  as  an  irritant  to  such 
fibres  may  produce  atony  of  the  stomach  wall  through  over- 
stimulation  of  the  inhibitors;  what  is  much  more  likely, 
through  an  exhaustion  of  the  forces  associated  with  the  nerve, 
there  will  be  an  unopposed  action  of  the  tissues  and  hence  a 
final  condition  of  weakness  with  dilatation.  It  has  been  said 
that  there  are  special  osteopathic  centers  for  controlling  the  car- 
diac and  pyloric  orifices,  situated  respectively  in  the  upper 
and  the  lower  gastric  areas,  i.  e.,  fourth  to  ninth  thoracic. 
Physiological  evidence  is  not  entirely  satisfactory  in  this  re- 
spect though  most  investigators  are  agreed  that  the  sympa- 
thetic fibrils  from  the  upper  area  do  exercise  a  relaxing  func- 
tion in  case  of  the  cardiac  orifice  while  less  evidence  is  ob- 
tainable in  case  of  the  pylorus.  . 

The  thoracic  region  from  the  seventh  to  the  tenth  or 
eleventh  is  the  vaso-motor  region  for  the  liver,  spleen,  and  pan- 
creas. The  area  for  these  viscera  is  not  very  definitely  marked 
out  but  sufficient  evidence  has  been  secured  to  show  that  this 
part  of  the  cord  gives  off  fibres  which  supply  these  accessory 
glandular  structures.  It  is  further  known  that  the  portal  sys- 
tem of  veins  is  innervated  by  similar  fibres  from  the  same  re- 
gion. Hence  various  conditions  of  disordered  digestion  may  re- 
sult from  interference  with  the  blood  supply  to  these  structures . 


320  PRINCIPLES   OF   OSTEOPATHY. 

Obstructive  jaundice  is  a  fairly  common  condition  met  with  in 
practice  and  is  due  to  swelling  and  infiltration  of  the  mucous 
lining  of  the  bile  duct  which  in  turn  is  dependent  upon  the  in- 
terference with  the  blood  supply.  Congestion  of  the  liver  sub- 
stance or  hypertrophy  following  such  congestion,  or  an 
atrophy  following  the  hypertrophy,  are  also  met  with  and  are 
dependent  upon  disordered  blood  conditions  part  of  which 
may  come  from  spinal  lesion.  The  spleen  is  occasionally  con- 
gested dependent  upon  disorder  of  its  vaso-motor  mechanism. 
Since  the  spleen  represents  a  part  of  the  circulatory  appara- 
tus and  is  directly  concerned  with  the  formation  and  disin- 
tegration of  red  blood  corpuscles  the  importance  of  a  lesion 
to  its  nerve  supply  is  obvious.  The  spleen  as  a  whole  is 
merely  an  expanded  and  many -chambered  blood  vessel  and 
undergoes  a  special  rhythm  of  its  own  through  the  periodic 
contraction  of  the  strong  muscular  fibres  in  its  capsule  and 
trabeculse.  A  disorder  of  the  pancreas  may  be  the  occasion 
for  various  symptoms  dependent  on  obstructed  nutritive  con- 
ditions. These  symptoms  are  usually  not  peculiar  and  are  not 
often  referred  to  the  pancreatic  disorder.  It  is  entirely  reason- 
able, owing  to  the  fundamental  importance  of  the  pancreas 
to  the  digestive  processes,  to  assume  that  the  organ  is 
often  responsible  for  presence  of  digestive  disorders.  Recent 
investigations  relating  to  the  glycogenic  function  of  the  pan- 
creas tend  to  emphasize  more  and  more  the  importance  of 
this  organ,  its  normal  action  being  essential  for  the  transfor- 
mation of  glycogen  into  sugar  and  of  sugar  into  glycogen. 
Disturbance  of  this  normal  action  may  account  for  many  of 
the  cases  of  diabetes  mellitus  formerly  supposed  to  be  due  to 
liver  or  even  to  kidney  disorder.  This  same  region  of  the 
cord  in  all  probability  may  in  addition  to  supplying  these 
structures  with  vaso-  motor  fibres  give  off  fibres  of  a  definite 
and  direct  secretory  function,  i.  e.,  exercising  an  influence 
directly  upon  the  secreting  cells  wilhout  reference  to  the  con- 
trol of  the  amount  of  blood.  For  this  belief  there  is  but  little 
direct  experimental  evidence.  Inasmuch  as  certain  other 


THORACIC   AND   LUMBAR   LESIONS — EFFECTS.  321 

glandular  structures  of  the  body  are  known  to  be  supplied  by 
sympathetic  secretory  nerves,  e.  g.,  salivary  glands,  it  is  not 
unreasonable  to  assume  a  similar  control  for  these  digestive 
glands.  It  has  further  been  shown  experimentally  that  this 
region  of  the  spine  receives  fibres  directly  from  the  viscera 
through  the  sympathetic  system  carrying  sensory  or  afferent 
impulses.  Hence  lesion  in  this  part  may  interfere  with  the 
normal  flow  of  impulses  from  the  viscera  to  centers  and  re- 
flexly  produce  various  sensory  and  motor  disorders  of  imme- 
diate or  more  remote  organs. 

The  region  of  the  spine  from  the  middle  thoracic  to  the 
coccyx  represents  the  area  of  innervation  for  the  intestines, 
and  hence  lesion  of  any  part  of  this  area  may  reasonably  pro- 
duce the  various  disorders  which  are  common  to  the  intestinal 
tract.  And  experience  indicates  that  it  is  not  theory  but  fact. 
For  instance  lesions  producing  constipation  have  been  found 
as  high  as  the  fourth  dorsal  and  as  low  as  the  coccyx.  A 
consideration  of  the  distribution  of  the  function  of  the  sym- 
pathetic filaments  in  this  region  throws  light  upon  the  ques- 
tion. It  has  already  been  stated  that  in  the  splanchnic  nerves 
are  to  be  found  fibres  subserving  the  function  of  motion  to 
the  abdominal  blood  vessels.  Among  the  latter  must  be  in- 
cluded those  distributed  to  the  mesenteries  and  thence  to  the 
bowel  walls.  It  is  further  stated  that  vaso-motor  fibres  have 
been  shown  to  pass  from  the  solar  plexus  to  supply  the  portal 
system  of  veins.  Hence  both  the  arterial  and  venous  systems 
of  the  intestinal  structures  are  more  or  less  subject  to  vaso- 
motor  control.  An  excess  of  blood  from  vaso- dilatation  will 
cause  one  or  both  of  two  effects,  i.  e.,  increase  of  intestinal  se- 
cretion and  stimulation  of  the  motor  organs  in  the  intestinal 
walls.  In  these  walls  in  connection  with  the  submucosa  and 
muscle  layers  are  found  the  double  set  of  ganglionic  struc- 
tures, Meissner-BillrotJi1  s  and  AuerbaM  s  plexuses.  It  is  believed 
that  these  act  as  local  distributing  points  for  secretory  and 
motor  influences  respectively.  An  increase  of  blood  to  these 
regions,  therefore,  may  easily  produce  excess  of  secretion 


322  PRINCIPLES   OF  OSTEOPATHY. 

and  of  motion  with  a  resulting  over-active  peristalsis  in  which 
both  factors  are  usually  concerned.  Hence  a  condition  of 
diarrhoea  with  or  without  inflammation  is  often  the  result.  It 
must  not  be  assumed  that  the  excessive  activity  will  be  the 
constant  accompaniment  of  the  excess  of  blood.  It  is  not  un- 
reasonable that  a  venosity  of  the  blood  resulting  from  the 
continued  dilatation  may  cause  a  final  exhaustion  of  the 
functioning  powers  of  the  bowel  wall  and  the  opposite  of  diar- 
rhoea, i.  e.,  constipation  will  result.  Naturally,  other  than 
these  two  conditions  may  occur  as  an  effect  of  the  local  dis- 
turbance of  blood.  It  is  safe  to  say  that  any  pathological  con- 
dition possible  to  a  similar  structure  will  result,  depending 
alone  on  the  cause  above  mentioned,  or  by  making  conditions 
which  are  predisposing  to  other  factors  in  producing  disease. 
Interference  with  the  constrictor  filaments  in  the  splanchnic  will 
cause  effects  at  least  temporarily  more  or  less  opposite  to 
those  associated  with  dilatation,  i.  e.,  ischaemic  states  which 
lessen  secretion  and  motion.  But  in  either  case  the  ultimate 
condition  is  likely  to  be  congestion  since  the  nerve  mechanism 
will  at  length  become  worn  out,  leaving  the  inherent  elasticity 
of  the  vessel  wall  as  the  only  factor  to  limit  the  amount  of 
blood  present. 

There  are  in  addition  to  to  the  vaso-motor  fibres  also  the 
viscero-inhibitors.  It  is  usually  stated  that  the  sympa- 
thetics  are  inhibitors  to  the  muscle  tissue  in  the  walls  of  the 
alimentary  tract  and  that  the  cranial  (vagus)  and  spinal 
(sacral)  are  motor.  While  the  view  is  largely  correct  there 
are  evidences  showing  that  both  the  cerebro- spinal  and  sym- 
pathetic systems  are  motor  and  inhibitor.  This  latter  fact  is 
not  by  any  means  proved  from  the  common  experience  of  os- 
teopaths that  a  so-called  stimulating  treatment  to  the  spine  is 
more  favorable  in  constipation  while  the  inhibitory  applica- 
tion is  most  successful  in  diarrhoea.  There  are  too  many  as- 
sociated factors  in  the  problem  to  make  such  a  generalization. 
In  this  connection  it  is  advisable  to  note 'that  the  crossed  in- 
rvation  theory  of  Basch  has  been  disproved.  This  theory  is 


THORACIC   AND   LUMBAR   LESIONS — EFFECTS.  323 

one  which  has  been  incorporated  in  various  text  books  and 
conclusions  have  been  drawn  from  it  for  which  there  is  no 
justification.  In  brief  it  is  that  the  cerebro- spinal  and  sym- 
pathetic systems  both  send  motor  fibres  to  one  coat  and  in- 
hibitory fibres  to  the  other,  and  that  the  two  are  opposite  in 
action  in  each  of  the  coats.  Along  this  line  a  quotation  of 
two  paragraphs  from  Langley  recorded  in  Schafer's  Text 
Book  of  Physiology  may  not  be  amiss:  "It  has  been  asserted 
that  in  the  gut,  the  internal  generative  organs  and  the  blad- 
der, there  is  an  essential  difference  in  the  character  of  the 
nerve  fibres  received  from  the  sympathetic  and  of  those  re- 
ceived from  the  vagus  or  from  the  pelvic  nerve,  of  such  sort 
that  the  sympathetic  fibres  cause  contraction  of  the  circular 
muscular  coat  and  inhibition  of  the  longitudinal  muscular 
coat;  whilst  the  vagus  and  pelvic  nerve  cause  inhibition  of 
the  circular  muscular  coat  and  contraction  of  the  longitudinal 
muscular  coat.  A  considerable  number  of  observations 
which  have  been  made  on  the  several  organs,  show  that  this 
is  not  the  case.  And  in  the  course  of  investigation  into  the 
innervation  of  the  pelvic  viscera  by  Anderson  and  myself, 
results  were  obtained  entirely  inconsistent  with  this  theory. 
Thus  for  example  stimulation  of  the  sympathetic  causes  the 
most  striking  longitudinal  contraction  of  the  vas  deferens, 
and  in  the  rabbit  the  most  obvious  inhibition  of  the  longi- 
tudinal coat  of  the  descending  colon;  and  on  the  other  hand 
stimulation  of  the  pelvic  nerve  causes  in  the  rabbit,  in  cer- 
tain circumstances,  complete  and  powerful  contraction  of 
the  circular  coat  of  the  descending  colon  and  rectum.  In  one 
case  only  is  there  prima  facie  ground  for  the  theory.  The 
pelvic  nerve  causes  great  contraction  of  the  recto-coccygeal 
muscle;  and  the  sympathetic,  if  it  has  any  effect  at  all,  which 
is  not  quite  certain,  has  an  inhibitory  effect."  (pp.  692-3, 
Vol.  II.)  "Recent  observations  have  strengthened  the  gen- 
eral conclusions  arrived  at  in  the  next,  that  the  cranial  auto- 
nomic  system  sends  motor  fibres  to  both  coats  of  the  gut,  and 
that  the  sympathetic  system  sends  inhibitory  fibres  to  both 


324  PRINCIPLES    OP   OSTEOPATHY. 

coats.  With  regard  to  this  it  is  to  be  borne  in  mind  that  the 
motor  effect  produced  by  stimulating  a  particular  nerve 
strand  varies  somewhat  in  different  animals,  in  different  parts 
of  the  gut,  and  in  different  circumstances.  The  observations 
strengthen  also  the  view  that  the  cranial  system  sends  some 
inhibitory  fibres,  and  the  sympathetic  system  some  motor 
fibres  to  both  coats,  but  it  is  clear  that  these  fibres  vary  in 
number  in  the  nerves  to  the  different  parts  of  the  gut  and  in 
different  animals;  and  although  it  is  perhaps  probable  that 
such  fibres  occur  generally  in  animals,  further  evidence  is 
required  to  place  this  view  on  a  sound  basis."  (pp.  695,  Vol. 
II.) 

From  the  foregoing  it  will  be  manifest  that  no  definite 
rules  can  be  given  with  regard  to  the  effect  of  any  particular 
lesion  upon  the  motor  activities  of  the  hollow  viscera,  and  as 
a  matter  of  fact  from  actual  experience  it  is  found  that  the 
same  lesion  in  different  individuals  will  produce  different  ef- 
fects, or  in  the  same  individual  a  lesion  will  produce  different 
effects  at  different  times.  Further  it  is  rather  unsafe  to  make 
definite  rules  regarding  the  part  of  the  bowel  likely  to  be  affect- 
ed. In  general  both  anatomical  and  physiological  facts  and 
clinical  experience  suggest  that  the  higher  the  lesion  in  the 
spinal  area  the  higher  will  be  the  pathological  condition  in  the  in- 
testinal canal.- 

Ovarian  and  uterine  disorders  are  quite  often  result- 
ing conditions  from  muscular  contracture  or  vertebral  lesion 
from  the  ninth  to  the  twelfth,  as  well  as  from  regions  lower 
down.  The  explanation  is  not  particularly  difficult  since 
fibres  forming  the  ovarian  plextis,  which  is  one  secondary  to 
the  solar  plexus,  have  been  traced  back  to  the  ganglia  of  the 
sympathetic  cord  in  this  region.  These  fibres  are  largely 
vaso-motor'vs\  function  and  hence  control  the  amount  of  blood 
to  the  ovary  and  uterus.  In  ovarian  colic  it  is  quite  common 
to  find  marked  muscle  contracture  in  these  spinal  tissues 
which  may  be  either  primary  or  secondary.  Inflammatory 
conditions  of  this  organ  will  also  be  associated  with  similar 


THORACIC   AND   LUMBAR   LESIONS — EFFECTS.  325 

lesions  while  disturbances  of  the  menstrual  period  and  various 
other  uterine  disorders  are  quite  commonly  dependent  upon 
the  lesion.  Through  this  same  channel  pass  sensory  fibres 
from  the  uterus  and  ovary. 

From  the  tenth  thoracic  to  the  first  or  second  lumbar  is 
represented  the  typical  region  for  kidney  disorders.  From 
the  lower  two  or  three  thoracic  ganglia  more  especially  from 
the  last  and  occasionally  from  the  upper  lumbar  ganglia,  arise 
fibres  that  pass  to  form  the  least  splanchnic.  This  nerve  is 
distributed  in  large  part  to  the  renal  vessels  from  whence 
they  are  carried  to  the  arterioles  in  the  renal  substance. 
They  exercise  a  control  over  the  lumen  of  the  arterioles  and 
thus  regulate  the  rapidity  of  the  excretory  function  of  the  kidney, 
for  it  is  known  that  the  excretion  varies  directly  with  the 
blood  flow  and  blood  pressure  in  the  arterioles.  Lesions  in 
this  region  of  the  spine  will  therefore  produce  congestions, 
disturbed  urinary  secretion,  inflammations,  and  other  dis- 
orders associated  with  a  disturbed  blood  supply.  Further 
some  of  the  sympathetic  fibrils  have  been  traced  into  the 
membrane  supporting  the  epithelial  cells  of  the  tubules  which 
suggests  a  direct  control  of  the  secretion  process,  although 
little  experimental  evidence  for  such  a  control  has  been  pre- 
sented. Some  of  the  fibres  associated  with  the  renal  plexus 
are  also  afferent  and  convey  the  sensations  of  pain  which  are 
common  accompaniments  of  kidney  disorders,  and  also  sub- 
serve the  function  of  afferent  pathways  for  the  kidney  reflexes. 
It  has  been  found  that  strong  quiet  pressure  in  this  region  of 
the  spine  is  often  effective  in  reducing  the  pain  associated 
with  renal  colic.  In  this  condition  the  renal  calculus  is  passing 
through  the  ureter  and  it  is  the  irritation  from  its  presence 
that  causes  the  extreme  distress.  Quain  states  that  sensory 
nerves  from  the  ureter  pass  through  the  last  three  thoracic 
and  first  lumbar  ganglion. 

In  the  lumbar  portion  of  the  sympathetic  system  are 
found  numerous  fibers  given  off  to  supply  .the  abdominal 
aortic  plexus  through  which  they  are  continued  downward 


326  PRINCIPLES   OF   OSTEOPATHY. 

into  the  formation  of  the  hypogastric  plexus,  which  £also 


-L 


FIG.  30.— Showing  innervation  of  pelvic  structures. 

receives  filaments  direct  from  the  lumbar  ganglia.  Through 
interference  with  the  action  of  these  fibres  various  diseases 
of  the  pelvic  structures  may  result.  Motor  fibres  to  the  bladder 
are  among  those  given  off  from  the  hypogastric  plexus  as 
well  as  their  antagonists,  the  inhibitors.  Lesion,  therefore, 
could  reasonably  produce  a  disturbance  of  micturition.  Note 
that  the  capacity  of  the  bladder  and  hence  the  frequency  of 
micturition  depends  in  part  upon  the  tone  of  the  bladder  loall.  Where 
this  is  excessive  there  will  be  the  symptom  of  increased  fre- 
quency of  discharge.  This  suggests  a  hyper-activity  of  the 
motor  fibres.  On  the  other  hand  an  exhausting  lesion  to 
these  fibres  will  produce  loss  of  tone  and  hence  an  incom- 
plete and  infrequent  discharge.  Disturbance  to  the  fibres 
that  supply  the  sphincter  mechanism  will  produce  incontinence 
of  urine.  This  latter  condition  is  one  very  commonly  found 


THORACIC    AND   LUMBAR   LESIONS — EFFECTS.  327 

associated  with  children  and  is  usually  dependent  upon  lesion 
in  the  lumbar  region.  This  lesion  may  interfere  with  the  out- 
going impulses  or  with  the  center  which  is  located  in  the  ter- 
minal portion  of  the  cord.  There  is  some  evidence  also  that 
•vaso-motor  fibres  are  distributed  to  the  bladder  from  the  lumbar 
sympathetic.  Interference  with  these  may  reasonably  produce 
various  disorders  of  nutrition  including  congestions  and  in- 
flammations. 

Disorders  of  the  generative  organs,  both  internal  and 
external,  are  common  accompaniments  of  lumbar  lesions. 
These  are  dependent  upon  the  fact  that  vaso-motor  fibres  to 
some  of  the  structures  and  motor  fibres  to  others  pass  through 
the  hypogastric'and  pelvic  plexuses  to  reach  the  organs. 

Throughout  the  entire  lower  thoracic  and  lumbar  regions 
impulses  are  given  off  by  the  sympathetic  fibrils  which  keep 
up  the  normal  chemical  and  muscular  tone  of  the  various  ab- 
dominal and  pelvic  structures.  Among  these  must  be  in- 
cluded the  supporting  tissues,  i.  e.,  the  ligamentous  and 
peritoneal  tissues  and  the  abdominal  walls  which  are  con- 
cerned in  affording  mechanical  support  to  each  of  the  several 
organs.  If  through  spinal  lesion,  either  general  or  local,  the 
nutrient  influences  be  in  part  withheld  these  supporting 
structures  must  of  necessity  become  lax  and  either  a  general 
or  local  ptosis  will  result.  In  a  typical  case  of  enteroptosis 
this  appearance  of  weakened  supportis  striking.  The  abdomi- 
nal walls  are  flabby,  the  abdominal  contents  lax,  yielding, 
and  prolapsed,  all  suggesting  a  condition  of  more  or  less 
complete  loss  of  tone.  Hence  in  addition  to  the  effects 
resulting  from  the  primary  lesion  there  will  b  e  added  con- 
sequences from  a  general  crowding  of  abdominal  con- 
tents downward  toward  the  pelvic  cavity.  This  natural- 
ly will  result  in  any  one  or  more  of  a  vast  number  of  dis- 
orders such  as  constipation,  bowel  obstruction,  or  appen- 
dicitis; ovarian  and  uterine  disturbance;  interrupted  excre- 
tory functioning  and  the  like.  (For  a  comprehensive  study 
of  this  problem  the  reader  is  referred  to  the  chapter  on  "The 


328  PRINCIPLES   OF   OSTEOPATHY. 

Abdomen,"  in  Dr,  Still'8  Philosophy  and  Mechanical  Principles 
of  Osteopathy. ~) 

Finally  through  the  connection  between  the  lumbar  sym- 
pathetics  and  the  spinal  nerves,  various  disorders  of  the 
lower  limbs  may  result.  Vaso  -motor  disturbances  of  the 
skin  producing  eruptions  and  irritations,  disorders  of  secretion 
of  sweat  and  sebum;  while  inflammatory  lesions  of  the  sciatic 
and  other  nerves  are  common. 

DIRECT  PRESSURE  FROM  RIBS. 

It  is  necessary  to  note  that  so  far  as  both  experience  and 
abstract  theory  are  concerned  a  rib  lesion  may  be  responsible 
for  the  same  kind  of  disorders  that  are  known  to  be  associated 
with  lesions  in  the  thoracic  spine.  Not  only  that  but  the  re- 
sults are  largely  produced  in  the  same  way,  i.  e.,  through 
the  mediation  of  disturbed  sympathetic  connections  and  in- 
terference with  the  spinal  nerves.  But  there  are  other  possi- 
ble and  common  disorders  associated  with  rib  subluxations 
that  are  not  produced  so  commonly  by  the  vertebral  disorder. 
Various  of  the  thoracic  organs  are  occasionally  involved  in 
disorder  through  a  direct  pressure  condition.  Reference  has 
been  made  to  the  condition  of  &flat  chest  as  one  type  of  gener- 
al rib  disorder.  This  flattening,  in  so  far  as  the  organs  are 
unable  to  adjust  themselves  to  the  changed  shape,  must  of 
necessity  interfere  with  their  normal  activity.  There  is  pro- 
vided for  each  thoracic  organ  a  certain  amount  of  room  in 
which  to  perform  its  function.  When  that  space  is  encroach- 
ed upon  by  an  approximation  of  the  thoracic  walls  disorder 
will  almost  certainly  result.  Typically  we  find  resulting  from 
the  flattened  chest  some  disorder  of  the  lungs.  The  majority 
of  individuals  who  are  afflicted  with  pulmonary  consumption 
present  this  flattened  type.  Along  with  the  lessening  in  the 
antero-posterior  diameter  there  will  also  be  a  limited  chest 
expansion.  This  will  be  due  in  part  to  a  loss  of  vitality  in 
the  respiratory  mechanism  itself  but  in  part  to  a  lessened 
pliability  of  the  chest  wall  dependent  on  a  proportionately  in- 


THORACIC  AND   LUMBAR  LESIONS — EFFECTS.  329 

creased  amount  of  non-  elastic  tissue.  While  such  a  condi- 
tion is  not  entirely  a  direct  pressure  on  the  lung  structures, 
yet  in  so  far  as  it  prevents  a  normal  expansion  of  the  lung 
tissue  it  is  the  same  in  effect.  In  connection  with  this  flatten- 
ed condition  associated  with  tuberculosis  it  is  a  significant 
fact  that  the  apical  portion  of  the  lung  first  becomes  involved. 
In  part  this  may  be  explained  on  the  fact  that  there  is  a  less- 
ened exercising  of  this  region  of  the  lung  whenever  the  flat 
condition  is  present.  It  is  noted,  however,  that  it  ia  not  the 
extreme  apex  that  first  is  involved,  but  a  point  an  inch  or  two 
below  the  apex.  This  corresponds  to  the  region  across  which 
passes  the  upper  part  of  the  sternum  and  anterior  ends  of  clavicle  and 
first  rib — a  fact  which  is  quite  suggestive. 

In  the  same  way  various  disorders  of  the  heart  may 
arise.  Normally  the  heart,  a  trifle  above  its  apex,  lies  in 
direct  contact  with  the  chest  wall  with  only  the  pericardium 
interposed.  This  point  is  in  the  region  of  the  fifth  rib  below 
and  internal  to  the  left  nipple.  It  is  manifest  that  a  narrowed 
chest  in  this  region  may  interfere  with  the  normal  action  of 
the  heart.  As  a  matter  of  clinical  experience  it  is  found  that 
such  a  condition  is  fairly  common.  The  author  has  seen  case 
after  case  of  palpitation  and  other  irregular  heart  action,  as 
well  as  disorders  of  a  more  serious  nature,  temporarily  ^and 
permanently  relieved  by  the  simple  expedient  of  opening  up 
the  chest  cavity  by  various  of  the  methods  for  elevating  the 
ribs.  It  has  been  stated  that  the  fifth  rib  is  more  commonly 
involved  in  such  cases  where  a  single  rib  produces  the  pres- 
sure effect.  From  personal  experience  the  author  Is  not  ready 
to  assent  to  this  proposition  though  it  may  reasonably  be  true. 
In  most  cases  where  a  true  direct  pressure  effect  is  produced 
it  is  a  condition  involving  a  series  of  ribs  rather  than  a  single 
one.  There  is  at  present  (1903)  a  case  in  the  clinic  depart- 
ment of  the  American  School  presenting  all  the  evidences  of 
angina  pectoris.  The  lesion  is  a  distinct  depressed  thorax 
and  relief  is  usually  obtained  by  attention  to  increasing  the 
chest  capacity.  Another  case  which  came  under  the  personal 

23 


330  PRINCIPLES   OF  OSTEOPATHY. 

observation  of  the  writer  was  one  of  bradycardia.  The  case 
was  one  of  long  standing-  and  little  discomfort  seemed  direct- 
ly traceable  to  it.  The  heart  rate  when  first  examined  was 
about  fifty.  No  lesion  aside  from  a  generally  lessened  an- 
tero- posterior  diameter  of  the  chest  could  be  detected  and  it 
was  decided  that,  provided  the  condition  was  not  a  normal 
one,  it  was  due  to  this  depression.  Treatment  was  directed 
to  the  elevation  of  the  ribs  with  a  result  rather  surprising  as 
well  as  gratifying.  Within  three  months  the  heart  rate  was 
increased  to  sixty -five.  Treatment  was  then  discontinued 
but  the  heart  rate  remained  at  this  figure  while  the  patient's 
general  condition  was  considerably  improved. 

The  abdominal  organs  may  suffer  as  a  direct  result  of 
the  thoracic  depression.  While  the  practice  of  tight  lacing 
has  been  in  recent  years  very  considerably  modified  it  is  still 
indulged  to  a  sufficient  extent  to  furnish  a  large  number  of 
cases  presenting  deformed  lower  thoracic  regions  with  con- 
sequent disorder  of  abdominal  and  pelvic  viscera.  It  is  per- 
fectly apparent  to  one  who  knows  the  structural  conditions 
involved  that  any  force  that  continually  depresses  the  lower 
part  of  the  chest  must  of  necessity  produce  a  ptosis  condition 
of  the  abdominal  organs.  As  a  result  of  this,  ill  effects  on 
the  pelvic  viscera  are  sure  to  follow.  Dr.  Still,  in  his  Me- 
chanical Principles  of  Osteopathy  has  emphasized  the  importance 
of  the  abdomen  and  the  effects  of  a  crowded  condition  of  its 
viscera  upon  the  pelvic  structures.  We  are  personally  persuad- 
ed that  a  large  number  of  the  diseases  affecting  the  latter  are 
directly  traceable  to  visceral  displacements  in  the  abdomen 
due  to  depressed  rib  conditions.  Case  after  case  presents 
itself  in  which  all  varieties  of  abdominal  and  pelvic  disorders 
are  undoubtedly  due  to  the  weakened  lower  thoracic  and  ab- 
dominal structures.  The  liver  is  often  found  occupying  a 
position  much  below  its  ordinary  situation.  This  usually  re- 
sults in  disturbance  of  its  own  metabolism  and  various  diges- 
tive disorders  result.  But  owing  to  its  displaced  condition 
the  more  serious  effects  are  found  in  connection  with  the 


THORACIC   AND   LUMBAR   LESIONS— EFFECTS.  331 

other  viscera  which  become  affected  secondarily  to  the  liver 
disorder.  This  is  strikingly  true  of  kidney  disorders.  Statis- 
tics show  that  the  majority  of  cases  of  floating  kidney  are  as- 
sociated with  the  right  side.  Normally  the  right  kidney  oc- 
cupies a  lower  level  than  does  the  left  on  account  of  the  conti- 
guity of  the  liver.  Downward  displacements  of  the  latter  will 
therefore  help  to  explain  the  greater  frequency  of  displace- 
ment of  the  right  kidney.  It  is  entirely  likely  that  with  more 
careful  observation  such  cases  will  present  a  fairly  typical 
depressed  chest  in  the  lower  half  of  the  thorax.  The  relation 
of  the  last  rib  to  the  kidney  should  be  noted.  Generally  the  rib 
crosses  the  junction  of  the  upper  with  the  middle  third  of  the 
kidney,  the  latter  lying  directly  in  front  and  only  separated 
from  it  by  adipose  tissue  and  the  margin  of  the  diaphragm  at 
the  attachment  of  the  latter  to  the  rib.  Hence  a  marked  lux- 
ation of  this  rib,  which  is  not  at  all  uncommon,  may  be  of 
itself  sufficient  to  severely  impair  the  position  or  condition  of 
the  organ.  Occasionally  cases  are  met  with  showing  more 
or  less  serious  interference  with  the  renal  function  which  are 
most  satisfactorily  explained  in  this  way. 

The  stomach  and  intestines  may  suffer  from  direct 
pressure  conditions.  Not  that  the  rib  or  cartilages  are  suffi- 
ciently close  to  exert  the  pressure  on  the  walls  of  these  or- 
gans. For  it  must  be  remembered  that  in  the  quiet  and  empty 
condition  the  stomach  does  not  lie  in  contact  with  the  ab- 
dominal or  thoracic  wall.  Only  when  it  is  considerably  dis- 
tended does  it  crowd  the  associated  viscera  aside  and  come 
into  relation  with  the  anterior  wall  of  the  abdomen.  But 
through  the  general  crowding  of  the  viscera  in  the  narrow 
chest,  the  stomach  as  well  as  other  of  the  abdominal  organs 
will  suffer.  In  the  same  way  disorders  of  the  intestines  are 
often  caused.  Enteroptosis  is  a  condition  very  often  associ- 
ated with  the  tapering  chest.  This  may  be  in  part  due  to  a 
crowding  but  it  is  altogether  likely  that  spinal  lesion  will  also 
be  found  which  interferes  with  the  innervation  and  hence  the 
tonicity  of  the  bowel  and  its  supports.  Constipation  or  diar- 


332  PRINCIPLES   OF   OSTEOPATHY. 

rhoea  may  result  and  will  only  be  permanently   overcome  by 
attention  to  the  elevation  of  the  ribs. 

RIB  PRESSURE  ON  VASCULAR  CHANNELS. 

Rib  subluxations  are  undoubtedly  responsible  for  numer- 
ous- disorders  dependent  on  interference  with  the  vascular 
structures.  Owing  to  a  similarity  in  effect,  clavicular  lesions 
will  be  included  in  this  discussion.  Among  the  vessels  in- 
terfered with  are  those  passing  into  or  through  the  superior 
opening  of  the  thorax,  namely,  innominate,  carotid,  subclav- 
ian,  internal  mammary,  and  superior  intercostal  arteries,  the 
innominate  and  thyroid  veins,  and  the  thoracic  duct.  These 
with  their  branches  and  tributaries  are  all  more  or  less  sub- 
ject to  pressure  from  a  narrowed  antero- posterior  diameter 
of  the  opening,  the  average  diameter  of  which  according  to 
Gray,  is  about  two  inches.  Hence  in  order  that  there  shall 
be  no  impairment  of  function  of  any  of  the  forty  or  more 
structures  which  pass  through,  this  opening  must  be  main- 
tained in  its  diameter.  It  is  necessary  to  bear  in  mind  that 
the  effect  from  pressure  on  the  vessels  may  be  double,  i.  e., 
an  effect  on  the  part  to  which  the  vessel  carries  its  contents 
and  the  part  from  which  it  passes.  For  instance  if  the  pres- 
sure become  obstructive  to  the  flow  through  the  carotid  artery 
the  neck  and  cephalic  structures  will  suffer  from  lessened  nu- 
trition while  the  heart  will  be  irritated  because  of  a  greater 
resistance  to  the  blood  flow.  In  like  manner  pressure  on  the 
jugular  veins  will  produce  a  congestion  in  the  parts  which 
they  drain  as  well  as  lessening  the  total  inflow  into  the  heart 
with  a  possible  lowered  general  blood  pressure. 

From  the  lessened  diameter  lesion  therefore  the  physician 
may  find  occasional  disorders  of  the  heart  and  of  all  those 
structures  which  are  associated  with  the  distribution  of  the 
vessels  which  pass  through  the  superior  opening.  Hence 
disorders  of  the  head  and  neck,  of  the  arm  and  shoulder,  and 
of  the  upper  chest  and  mammary  regions  are  common.  "We 
have  known  of  congestive  headaches  relieved  by  lifting  up  the 


THORACIC   AND   LUMBAR  LESIONS — EFFECTS.  333 

anterior  upper  chest  structures.  Affections  of  the  thyroid 
gland  have  been  caused  by  a  closeness  of  structures  in  the 
region  of  the  inferior  thyroid  veins.  The  writer  knew  of  a 
case  of  vascular  goitre  temporarily  reduced  in  size  nearly 
one-half  by  a  single  treatment  designed  to  lift  up  the  an- 
terior end  of  the  clavicle  and  first  rib.  In  most  cases  of  goitre, 
however,  there  will  be  increase  in  parenchymatous  or  con- 
nective tissue  and  hence  the  student  should  not  expect  the 
swelling  to  disappear  immediately.  In  a  large  number  of 
cases  of  goitre,  whether  of  the  vascular  or  increased  tissue 
forms,  there  will  be  found  a  tightness,  primary  or  secondary, 
which  on  removal  will  give  much  relief  if  not  effecting  a  cure. 
In  the  dropping  back  of  the  anterior  end  of  clavicle  and  first 
rib  in  many  individuals  there  will  be  an  approximation  of 
these  two  structures  near  the  point  where  the  subclavian  ar- 
tery passes  over  to  become  the  axillary.  An  obstruction  of 
the  blood  flow  to  and  from  the  arm  will  likely  result  and 
greater  or  less  impairment  of  nutrition  follow.  This  will 
partly  depend  upon  the  effect  of  pressure  back  against  the 
subclavian  vessels  as  they  pass  upward  from  the  chest  cavity. 
A  branch  of  the  subclavian,  the  vertebral,  may  likewise  suf- 
fer and  hence  disorders  of  the  spinal  column  and  associated 
tissues  result.  Mammary  disorders  are  often  found  associated 
with  a  lessened  antero-posterior  diameter  of  the  opening,  and 
if  not  caused  by  such  lesion,  will  undoubtedly  be  aggravated 
by  it  or  prevented  from  immediate  recovery  of  function. 
Stagnation  of  lymph  from  pressure  upon  the  thoracic  duct  may 
occur.  This  duct,  carrying  the  lymph  received  from  the 
greater  part  of  the  body,  passes  into  the  cervico- thoracic  re- 
gion, bends  over  and  empties  into  the  subclavian  vein  or  the 
internal  jugular  at  the  junction  of  the  latter  with  the  former. 
This  structure  like  the  vein  has  little  resisting  power  and 
hence  less  pressure  from  without  will  be  required  to  impede 
the  flow  than  would  be  true  of  the  artery.  Dr.  Still  continu- 
ally emphasizes  the  importance  of  the  lymph  flow  for  normal 
conditions  of  nutrition  and  elimination,  and  in  this  connec- 


334  PRINCIPLES    OF   OSTEOPATHY. 

tion  the  relation  of  the  principal  vessel  of  the  system  to  the 
cervico-thoracic  structures  becomes  of  increased  importance. 
The  intercostal  system  of  vessels  is  of  much  import- 
ance in  connection  with  rib  subluxations.  When  it  is  re- 
membered that  a  depressed  thorax  means  an  obstruction  to 
more  than  twenty  arteries  and  as  many  veins,  all  of  compara- 
tively large  size,  the  significance  becomes  at  once  apparent. 
These  are  concerned  with  the  nutritive  condition  of  the  greater 
part  of  the  body  walls  as  well  as  to  structures  closely  associ- 
ated with  the  latter.  Any  number  and  variety  of  superficial 
chest  disorders  have  been  caused  by  various  of  the  rib  le- 
sions discussed  in  a  previous  section  and  it  is  an  entirely  rea- 
sonable assumption  that  they  are  at  least  in  part  dependent 
on  impaired  blood  flow  through  both  artery  and  vein,  by 
pressure  thereon  from  a  subluxated  rib  or  contractured  in- 
tercostal tissues.  The  significant  fact  that  many  cases  of 
ancemia  present  markedly  disturbed  chest  structures  should 
be  noted.  The  cancellous  tissue  within  the  rib  is  the  seat  of 
formation  of  red  corpuscles.  This  activity  is  necessarily  de- 
pendent on  a  free  delivery  of  blood  to  the  ribs  and  a  drainage 
from  them,  both  of  which  are  subserved  by  the  intercostal 
system.  It  is  known  that  in  anaemia  there  is  a  lessened  num- 
ber of  the  red  corpuscles  and  usually  a  lessened  total  amount 
of  blood.  It  is  not  unreasonable  that  the  depressed  chest  is  a 
factor  bearing  a  causal  relation  to  the  anaemic  state.  These 
vessels  further  supply  the  areolar  tissue  between  the  chest 
wall  and  pleura  as  well  as  distributing  branches  to  the  struc- 
ture last  named.  Hence  pleuritic  affections  may  be  caused  by 
the  obstruction,  or  more  likely  a  weakness  be  caused  which 
renders  the  tissue  more  susceptible  to  other  factors.  Dis- 
orders of  the  mammary  gland  are  very  commonly  associated 
with  rib  subluxations.  Slight  soreness,  considerable  inflam- 
mation, simple  tumor,  and  even  cancerous  conditions  have 
been  found.  We  are  not  prepared  to  affirm  that  a  true  con- 
dition of  the  latter  has  been  cured  by  overcoming  the  rib  le- 
sion. But  a  number  of  cases  diagnosed  as  such  have  with- 


THORACIC   AND   LUMBAR  LESIONS — EFFECTS.  335 

out  question  been  overcome  by  attention  merely  to  the  rib  dis- 
order,while  numerous  cases  of  simple  growths  and  congestive 
and  inflammatory  conditions  have  been  successfully  over- 
come. Lessened  secretion  of  milk  undoubtedly  has  resulted 
from  rib  subluxation.  A  few  cases  are  on  record  where  ex- 
tensive experimenting  along  lines  of  dieting  failed  to  produce 
a  flow  of  milk  sufficient  for  the  nourishment  of  the  child  where 
simple  adjustment  of  rib  disorder  permitted  a  marked  and 
sufficient  increase.  The  intercostal  system  of  vessels  has  its 
bearing  on  all  such  cases  and  it  is  not  unreasonable  that 
directly  as  well  as  indirectly  the  blood  flow  has  been  disturbed 
by  the  rib  lesion.  Note  that  the  supply  and  drainage  must 
pass  between  the  ribs  to  affect  the  gland.  Hence  contractured 
conditions  of  the  intercostal  muscles  as  well  as  subluxations 
of  the  ribs  themselves  may  reasonably  affect  the  flow. 

The  vessels  associated  with  the  diaphragm,  according 
to  Dr.  Still,  are  among  the  most  important  in  their  relation  to 
disease  conditions.  A  prolapsed  diaphragm  could  undoubted- 
ly produce  greater  or  less  disturbance  of  blood  flow  to  and 
from  the  heart.  Note  that  the  aorta  does  not  pass  through 
but  behind  the  diaphragm,  between  the  two  crura  of  that 
structure  as  they  pass  to  their  attachments  to  the  bodies  of 
the  lumbar  vertebrae.  In  case  of  a  marked  disorder  of  the 
diaphragm  there  could  be  produced  serious  impediment  to 
aortic  flow.  The  vena  cava  inferior  does  not  pass  through  the 
muscular  part  of  the  diaphragm  but  through  the  central- ten- 
don. Contracture  of  the  structure  would  therefore  interfere 
with  the  vein  by  tightening  the  fibrous  tissue  around  the 
opening  or  drawing  the  opening  to  one  side.  It  must  be  re- 
membered that  the  diaphragm  in  so  far  as  it  is  striate  muscle 
tissue  is  subject  to  the  same  conditions  of  contracture  as  are 
other  such  muscles.  If  but  a  part  of  the  muscle  be  involved 
in  a  hypertonic  or  an  atonic  condition  this  will  of  necessity 
produce  distortion  of  the  structure  as  a  whole,  by  virtue  of 
which  the  various  structures  which  pass  through  may  be  in- 
terrupted. Naturally  the  position  of  the  diaphragm  is  dependent 


336  PRINCIPLES   OF   OSTEOPATHY. 

on  the  condition  of  the  aix  lower  ribs  to  which  it  is  attached. 
Hence  if  a  luxation  of  one  or  more  of  these  be  present  a  great- 
er or  less  disturbance  of  the  diaphragmatic  tension  will  result, 
and  effects  immediate  or  remote  be  produced  through  impair- 
ment of  blood  or  nerve  flow  through  the  several  openings. 
Further  since  the  abdominal  structures  are  in  part  dependent 
upon  the  diaphragm  for  their  normal  position  displacement 
of  these  may  result  as  a  consequence  of  impaired  nutritive 
conditions  plus  the  loss  of  mechanical  support.  (For  an  ex- 
haustive discussion  of  the  osteopathic  considerations  of  the 
diaphragm  the  reader  is  referred  to  Hazzard's  Practice  of  Os- 
teopathy, p.  196.) 

RIB  PRESSURE  ON  NERVES. 

The  nerves  that  may  suffer  from  lesion  of  the  ribs  are  the 
same  as  those  referred  to  in  connection  with  the  spinal  lesion. 
In  addition  those  which  pass  through  the  upper  opening" 
of  the  thorax  are  likely  to  be  involved  in  the  crowding 
which  is  associated  with  the  lessened  antero-posterior  diameter 
of  the  chest.  Notably  is  this  true  in  case  of  ihepneumogastric. 
The  statement  is  often  seen  and  heard  that  a  backward  lux- 
ation of  the  inner  end  of  the  clavicle  or  the  associated  rib  will 
impinge  the  nerve.  This  is  not  entirely  true  since  the  nerve 
is  situated  rather  too  deeply  to  be  immediately  reached  by 
those  structures.  But  it  is  essentially  true  since  the  crowding 
of  all  the  structures  will  involve  this  nerve  equally  with  the 
others.  From  both  abstract  reasoning  and  clinical  observa- 
tion the  probability  of  such  a  condition  is  made  manifest. 
Many  cases  which  present  a  dry,  hacking  cough  are  seeming- 
ly entirely  dependent  on  this  crowded  condition.  The  writer 
has  seen  several  such  cases  temporarily  and  permanently  re- 
lieved by  adjustment  of  this  superior  thoracic  condition. 
Evidently  the  crowding  either  directly  or  reflexly  produces 
the  irritation  to  the  inferior  laryngeal  nerves  which  are  re- 
sponsible for  the  cough.  This  is  but  a  type  of  the  conditions 
that  may  result.  Any  of  the  other  functions  with  which  the 


THORACIC   AND   LUMBAR   LESIONS— EFFECTS.  337 

vagus  is  associated  may  be  similarly  involved.  The  phrenic 
also  passes  through  this  opening  and  might  be  equally  in- 
volved. But  so  far  as  actual  clinical  observation  shows,  it 
does  not  seem  to  be  so  frequently  disturbed  as  is  the  vagus. 
The  sympathetic  cords  both  pass  through  this  same  region  and 
are  subject  to  the  same  pressure  conditions.  The  numerous 
effects  resulting  therefrom  have  already  been  referred  to  in 
discussing  the  cervical  and  thoracic  spinal  lesions. 

Along  the  course  of  the  ribs  the  intercostal  nerves 
are  subject  to  obstructive  lesion  in  a  manner  similar  to  that 
spoken  of  in  connection  with  the  artery  and  vein.  Sensory 
disorders  such  as  neuralgias  are  common.  These  and  other 
conditions  that  cause  an  excess  of  impulses  to  pass  to  the 
spinal  cord  may  there  initiate  changes  which  will  have  far- 
reaching  effects.  Motor  disorders  are  frequently  noticed. 
These  are  contractures  and  spasmodic  conditions  Through  ir- 
ritation to  the  fibres  which  have  been  derived  from  the  sympa- 
thetic various  nutritional  changes  will  manifest  themselves 
in  the  chest  wall  and  mammary  gland.  In  connection  with 
the  latter  it  should  be  noted  that  while  experimental  physi- 
ology gives  little  evidence  for  any  direct  control  of  mammary 
secretion  by  the  nervous  mechanism  the  histological  findings 
together  with  the  known  conditions  in  analogous  structures 
make  it  extremely  likely  that  such  .direct  control  is  exercised, 
and  an  interference  with  which  will  most  certainly  produce 
greater  or  less  disorder.  In  all  likelihood  most  cases  with  vas- 
cular obstruction  are  equally  with  that  obstruction  dependent 
on  irritation  to  the  nervous  mechanism  of  the  gland. 


338  PRINCIPLES  OF   OSTEOPATHY. 

CHAPTER  XVI, 


PELVIC  LESIONS. 

An  understanding  of  the  structures  comprising  the  pelvis 
becomes  of  special  importance  when  the  practitioner  realizes 
the  variety  and  almost  infinite  number  of  disorders  that  may 
result  from  lesion  in  this  region.  Disorders  not  only  to  the 
organs  immediately  involved  but  through  the  reflex  those  re- 
motely situated.  Every  physician  of  experience  will  grant 
that  any  organ  of  the  body  may  suffer  as  a  result  of  a 
disturbance  of  the  generative  organs.  This  is  more  notice- 
ably true  in  case  of  the  female.  Gynecologists  are  becoming 
more  and  more  convinced  that  uterine  displacements  and  other 
interferences  with  the  condition  of  that  structure  are  account- 
able for  a  large  number  of  diseases  that  afflict  women.  While 
the  author  is  personally  convinced  that  the  claims  of  many 
of  the  gynecologists  are  quite  extravagant  in  this  respect,  it 
is  granted  that  there  is  sufficient  evidence  for  the  general 
proposition  to  make  it  advisable  to  give  special  attention  to 
the  consideration  of  female  diseases.  But  there  is  an  un- 
fortunate tendency  on  the  part  of  many  to  stop  their  investi- 
gation of  causes  with  the  determination  often  little  less  than 
pure  assumption,  of  a  reflex  connection  with  the  genital  dis- 
order. This  is  greatly  to  be  deplored.  While  it  is  without 
question  true  that  the  excess  of  impulses  from  a  hyper- irri- 
tated organ  may  be  responsible  for  disturbance  of  another 
viscus  in  close  nervous  connection,  yet  in  most  cases  where 
the  effect  on  the  second  organ  is  intense  in  degree  and  pro- 
longed in  time  the  reflex  is  not  the  only  causal  factor.  In 
many  cases  it  is  but  an  exciting  cause  acting  upon  an  already 
weakened  organ.  Osteopathic  gynecologists  insist  that  in  their 
experience  those  cases  of  uterine  disorder  which  always  af- 
fect the  heart  will  almost  invariably  be  found  associated  with 
a  lesion  condition  in  the  various  regions  typical  for  cardiac 


PELVIC   LESIONS.  339 

lesions.  This  will  be  the  experience  of  most  osteopaths  who 
are  sufficiently  careful  in  their  diagnosis,  and  will  be  true  of 
other  organs  besides  the  heart 

While  the  effects  from  pelvic  lesions  are  more  commonly 
related  to  the  generative  organs,  these  do  not  by  any  means 
constitute  all  of  the  possible  conditions;  but  owing  to  their 
unquestioned  paramount  importance  special  emphasis  is  laid 
upon  them. 

EXAMINATION  AND  DIAGNOSIS. 

The  pelvis  is  composed  of  that  part  of  the  body  whose 
walls  are  made  up  from  the  sacrum  and  coccyx  posteriorly, 
the  innominate  bones  laterally  and  anteriorly,  the  perineum 
forming  its  floor,  and  a  plane  passed  horizontally  through  the 
spines  of  thf  pubes  in  front  and  the  upper  level  of  the  sacrum 
behind  forming  its  upper  boundary.  Note  that  the  region 
above  this  plane  bounded  laterally  by  the  flaring  ilia  is  not 
properly  a  part  of  the  pelvis  though  often  spoken  of  as  such, 
but  constitutes  the  lower  part  of  the  cavity  of  the  abdomen. 

The  important  landmarks  serving  as  guides  to  the  diag- 
nostician are  the  following:  crest  of  the  ilium,  anterior  and 
posterior  spines  of  the  same,  the  sacro-lumbar  junction,  the 
ischia,  the  pubic  junction,  and  the  coccyx.  In  making  a  diag- 
nosis of  the  lesion  associated  with  almost  any  part  of  the  pel* 
vis  the  condition  and  position  of  several  of  these  structures 
will  be  taken  into  consideration.  Tt  is  quite  true  that  there  is 
little  likelihood  of  a  marked  disorder  of  one  part  of  the  pelvic 
framework  without  an  involvement  of  some  other  part.  A 
luxated  innominatum  will  usually  produce  disorder  of  its  fel- 
low or  of  the  coccyx,  and  distorted  conditions  of  the  coccy- 
geal  tissues  are  common  accompaniments  of  sacral  lesions. 
It  is  further  true  that  numerous  disorders  of  the  spine  and  ribs 
result  from  pelvic  lesions,  the  reasons  for  which  are  suffi- 
ciently obvious.  Hence  in  the  discussion  of  lesion  to  individual 
parts  of  the  pelvis  reference  must  continually  be  made  to  as- 
sociated lesion  of  other  parts. 


340  PRINCIPLES   OF  OSTEOPATHY. 

In  the  examination  of  the  pelvis  the  sitting  posture  is, 
all  things  considered,  the  most  satisfactory.  In  this  position 
the  tuber-ischia  are  supporting  the  body  and  any  disturbance 
in  their  relative  levels  may  be  indicated  by  the  position  as- 
sumed. If  one  of  the  innominata,  by  virtue  of  an  upward 
luxation  at  the  sacral  junction,  is  at  a  higher  level  than  its 
fellow  there  will  in  all  likelihood  be  a  double  lateral  swerve  of 
the  spine  to  compensate  for  the  condition  in  order  to  main- 
tain body  equilibrium.  In  long  standing  cases  of  such  a  dis- 
order the  lateral  swerve  in  the  lumbar  region  will  become 
more  or  less  permanent,  thus  constituting  the  secondary  and 
compensatory  spinal  curvature.  Resulting  from  this  lumbar 
swerve  there  will  be  in  many  cases  a  further  compensation  in 
the  thoracic  spine.  In  noting  the  levels  of  the  two  innomi- 
nata comparison  must  be  made  with  several  points.  The 
crest  of  the  ilium  in  normal  average  conditions  is  on  a  level  with 
the  fourth  lumbar  spine.  By  comparison  of  the  two  crests 
with  this  spine  some  data  may  be  gained  indicating  the  na- 
ture of  the  lesion.  Similarly  comparison  is  to  be  made  be- 
tween the  anterior  and  posterior  spines  of  the  ilia  as  well  as 
the  levels  of  the  ischia. 

In  speaking  of  an  upward  subluxation  of  the  ilium 
reference  must  be  made  to  the  direction  of  displacement.  In 
many  cases  of  such  lesion  of  the  innominatum  we  are  per- 
suaded that  the  condition  is  really  a  rotation  of  the  bone 
about  an  axis  passing  horizontally  through  the  pubic  articulation. 
Usually  the  cause  of  the  subluxated  innominatum  is  a  strong 
jarring  of  the  bone  transmitted  through  the  femur,  as  in  the 
case  of  stepping  abruptly  and  unconsciously  upon  a  lower 
level;  in  this  case  the  force  is  transmitted  by  the  weight  of  the 
spinal  column  through  the  sacrum.  In  either  case  the  ten- 
dency will  be  for  an  upward  sliding  of  the  innominatum  upon 
the  sacro-iliac  articulation  but  without  necessarily  a  similar 
upward  sliding  at  the  junction  of  the  two  parts.  Bear  in 
mind  the  fact  that  the  sacro-iliac  articulation  is  an  arthrodial 
or  gliding  joint  and  in  most  younger  individuals  is  supplied 


PELVIC    LESIONS. 


341 


with  the  typical  articular  structures  including  the  synovial 
membrane  and  fluid.  This  fact  suggests  a  fair  degree  of 
normal  movement  between  the  parts  and  a  considerable  pos- 


f 


Fig.  31. — Showing  axes  of  rotation  of  innominatum    (A.    A.)-    Also  effect  of 
body  weight  on  position  of  sacrum  and  coccyx. 

sibility  in  the  way  of  abnormal  relations.  On  the  other  hand 
injunction  of  the  pubes  admits  of  relatively  little  gliding  move- 
ment, the  articular  cartilages  being  joined  not  by  synovial 


342  PRINCIPLES   OF   OSTEOPATHY. 

structures  but  by  strong  fibrous  connections.  In  the  condi- 
tion of  upward  subluxation  there  will  be  a  twisting  of  the  in- 
ter-pubic softer  tissues,  which  is  usually  associated  with 
tenseness  and  tenderness  of  surrounding  tissues  but  with 
little  relative  change  of  levels,  although  in  some  cases  the 
rotation  may  be  sufficient  to  produce  a  noticeable  difference 
in  the  relative  antero-posterior  positions  of  the  spines  or  other 
prominent  parts  of  the  pubic  bones.  Owing  to  the  further 
fact  that  the  center  of  rotation  of  the  acetabular  articulation 
is  but  slightly  in  front  of  a  vertical  line  dropped  from  the  center  of 
gravity  of  the  body,  most  of  the  force  of  the  shock  will  be  re- 
ceived by  the  sacro-iliac  rather  than  the  pubic  articulation, 
with  a  consequent  tendency  to  produce  an  exaggeration  of 
the  normal  movement  of  that  articulation.  But  it  must  not 
be  assumed  that  all  such  upward  subluxations  are  rotations 
about  the  pubic  axis.  For  in  many  cases  there  will  be  a 
noticeable  difference  in  the  levels  of  the  corresponding  parts 
in  the  two  pubic  structures  which  suggests  either  an  upward 
gliding  of  the  entire  innominatum  or  a  rotation  about  an  arts 
passing  horizontally  through  the  sacro-iliac  articulation.  A  simple 
rotation  about  the  latter  axis  can  only  be  slight  in  degree 
since,  owing  to  the  long  arm  represented  by  the  extension 
forward  of  the  ramus  of  the  pubic  bone,  much  rotation  must 
result  in  extreme  movement  of  the  forward  end  of  the  arm. 
We  know  that  such  changes  as  are  found  in  the  levels  of  the 
pubic  structures  are  measured  in  millimeters  or  fractions  there- 
of rather  than  centimeters,  and  hence  the  rotation  about  the 
sacro-iliac  axis  must  of  necessity  be  quite  infinitesmal.  //  is 
not  to  be  assumed  that  the  infinitesmal  rotation  will  produce  in- 
finitesmal effects.  For  slight  as  it  may  be,  if  it  be  "off  its  cen- 
ter," through  continued  tension  and  other  irritation  which 
results  disorder  of  the  first  magnitude  may  follow.  A  simple 
twisting  strain  of  this  articulation  is  often  found  to  result  in 
quite  serious  disorder. 

With  reference  to  the  effect  of  a  subluxated  innominatum 
upon  the  length   of  the  limb  much  might  be  written  and 


PELVIC   LESIONS.  343 

still  the  subject  remain  open  to  dispute.  It  is  manifest  that 
the  upward  movement  of  one  innominatum  will  tend  to  pro- 
duce a  shortening  of  the  corresponding  limb.  But  this  cer- 
tainly is  not  an  invariable  rule.  In  some  cases  where  the  up- 
ward tendency  is  quite  manifest  in  the  various  diagnostic 
points  there  will  be  little  if  any  change  in  the  apparent  length 
of  the  limbs,  and  even  in  occasional  cases  there  will  be  an 
actual  lengthening  on  the  same  side.  The  rule  would  hold 
if  other  things  were  equal.  But  in  any  case  of  subluxation 
other  things  are  likely  to  be  quite  unequal.  Note  this  fact. 
Any  change  in  the  pelvic  articulations  will  almost  invariably  pro- 
duce a  disturbance  in  the  tone  of  the  muscles  and  other  softer  tissues. 
In  the  laboratory  it  can  be  shown  that  section  of  the  sciatic 
nerve  produces  a  distinct  difference  in  the  length  of  the  limb 
of  the  animal  experimented  upon.  This  is  explained  from 
the  known  facts  relating  to  the  tone  of  muscle  tissue.  Such 
tone  is  largely  dependent  upon  impulses  continually  passing 
to  the  muscle  over  its  nerve.  And  not  only  the  efferent  nerve 
but  afferent  impulses  are  essential  to  the  normal  tonic  condi- 
tion. If  the  dorsal  (afferent)  root  of  the  spinal  nerve  be  cut 
and  the  anterior  (efferent)  left  intact  a  marked  loss  of  tone  is 
produced.  This  suggests  that  any  interference  with  the  sen- 
sory nerves  may  produce  a  disturbance  of  the  tone  sufficient 
to  make  a  difference  in  the  length  of  the  muscles.  That  the 
length  of  the  limb  may  be  increased  by  the  lax  conditions  of 
the  muscle  tissue  is  proved  in  the  case  of  certain  of  the  lower 
animals.  It  is  reasonably  true  of  man  and  numerous  cases 
have  been  noticed  which  tend  to  substantiate  the  assumption. 
"We  have  personally  seen  cases  where  the  limb  could  actively 
and  passively  be  shortened  a  very  appreciable  distance.  In 
these  cases  it  is  necessary  to  consider  all  of  the  articulations  as 
being  involved  in  the  production  of  the  condition,  i.  e. ,  the  hip, 
the  knee,  and  the  articulations  associated  with  the  ankle  and 
foot.  An  examination  of  the  cadaver  does  not  usually  cause 
one  to  arrive  at  the  conclusion  that  the  head  of  the  femur  may 
play  up  and  down  appreciably,  but  the  cadaver  is  not  a  suffi- 


344  PRINCIPLES   OF   OSTEOPATHY. 

cient  proof  that  such  is  impossible.  On  the  other  hand  an 
irritating  lesion  of  the  pelvis  may  increase  the  tone  of  the  tis- 
sues with  a  consequent  shortening  of  the  limb  as  a  whole. 
This  condition  would  explain  the  shortened  limb  associated 
with  a  downward  luxation — a  case  exceptionally  noticed. 

In  determining  the  comparative  length  of  the 
limbs  several  methods  may  be  employed.  The  usual  one  is  a 
simple  comparison  without  tape  line  measurement.  "With  the 
patient  on  his  back  the  body  is  straightened,  the  limbs  equally 
disposed,  and  complete  relaxation  secured  as  far  as  is  possible 
by  the  patients  own  volition.  The  rotation  of  the  limbs  to 
secure  additional  relaxation  for  purposes  of  diagnosis  is  con- 
tra-indicated, since  the  relaxation  thus  secured  tends  to  par- 
tially, though  temporarily,  remove  the  lesion  and  make  its 
detection  less  easy.  With  the  patient  thus  disposed  and 
sources  of  error  eliminated  as  far  as  possible,  various  promi- 
nences on  the  limbs  are  compared,  the  most  satisfactory  of 
these  being  the  internal  malleoli.  Comparison'of  the  heels  of 
the  shoes  is  not  as  free  from  error  and  hence  is  not  advised. 
The  further  method  of  tape-line  measurement  has  its  advan- 
tages. Various  points  are  used  in  such  determination,  i.  e., 
from  the  teeth,  the  points  of  the  shoulders,  the  umbilicus,  the 
anterior- superior  spines  of  the  iliac  bones,  or  the  pubic  ar- 
ticulation. 

Having  by  various  means  determined  that  there  is  an 
appreciable  difference  in  the  length  of  the  limbs  due  to  other 
than  hip,  knee,  or  ankle  disturbances,  it  remains  to  determine 
which  limb  be  the  one  involved.  For  it  is  manifest  that  the 
shorter  or  longer  one  may  be  the  abnormal  part.  Usually 
there  is  little  difficulty  in  making  the  distinction.  The  tender- 
ness and  contracture  of  the  tissue  will  be  the  best  sign  where 
the  change  in  position  is  not  palpable.  In  the  average  case 
the  soreness  will  be  on  the  side  of  the  lesion  and  with  it  the 
contracture  and  tightening  of  muscle  and  ligaments.  There 
are  three  more  or  less  distinct  regions  of  the  pelvic  areas 
where  such  soreness  is  most  manifest,  the  sacro -iliac  articu- 


PELVIC    LESIONS.  345 

lation,  the  tissue  along  the  crest  of  the  ilium,  and  the  pubic 
articulation.  One  or  more  of  these  regions  will  almost  invari- 
ably present  marked  tenderness  to  pressure.  Occasionally 
similar  tender  areas  will  be  present  on  the  opposite  and  less 
involved  side,  but  in  most  cases  it  will  be  less  in  intensity. 
The  contracture  and  tightening  will  be  most  noticeable  just 
median  to  the  posterior  superior  spine  where  muscle  and  liga- 
mentous  structures  pass  from  innominatum  to  sacrum. 

The  posterior  superior  spines  of  the  ilia  are  impor- 
tant factors  in  diagnosis  of  the  relative  position  of  the  in- 
nominataand  sacrum.  In  an  upward  subluxation  or  a  forward 
rotation  around  either  of  the  axes  referred  to  there  will  be  a 
corresponding  upward  lifting  of  the  spine.  Where  the  ilium 
has  been  displaced  directly  forward  the  spinous  process  will 
appear  less  prominent,  while  if  backward  it  will  seem  unduly 
so.  An  upward  subluxation  may  produce  &  greater  depression 
median  to  the  spine  owing  to  the  rapid  forward  as  well  as  up- 
ward trend  of  the  posterior  surface  of  the  sacrum. 

The  anterior  superior  spine  of  the  ilium  is  a  land- 
mark of  less  value  in  diagnosis  of  innominatum  disorders 
than  is  the  posterior.  In  disturbed  relations  there  may  be  a 
difference  in  the  distances  between  the  spine  and  the  um- 
bilicus which  suggests  a  lesion  of  one  of  the  innominata. 
The  relative  level  of  the  two  is  also  an  important  guide. 

An  understanding  of  the  lesions  of  the  sacrum  neces- 
sitates a  consideration  of  the  mechanical  conditions  which 
accomplish  the  support  of  the  spinal  column.  In  the  first 
place  note  that  practically  the  entire  weight  of  the  body  with 
the  exception  of  the  lower  limbs  is  supported  upon  the  upper 
part  of  the  sacrum.  This  necessitates  an  extremely  strong 
mechanism  associated  with  the  junction  between  the  sacrum 
and  innominata.  The  sacrum  does  not  fit  in  between  the  two 
iliac  bones  in  such  a  manner  as  to  permit  of  a  perfect  wedge 
action,  owing  to  the  fact  that  its  upper  half  slopes  markedly  for- 
ward thus  permitting  the  spine  to  act  upon  it  at  an  angle. 
Hence  the  natural  tendency  of  the  weight  of  the  body  will 

23 


346  PRINCIPLES   OF   OSTEOPATHY. 

not  simply  be  the  forcing  of  the  wedge  between  the  iliac 
bones,  but  will  continually  tend  to  force  the  upper,  part  of  the 
bone  forward.  (See  Fig.  31.)  This,  as  is  pointed  out  by  Quain 
and  others,  will  be  prevented  to  a  considerable  extent  not 
only  by  the  posterior  sacral  ligaments  but  also  by  the  great 
sacro-sciatic  ligaments  which  anchor  the  lower  half  of  the 
sacrum  strongly  to  the  ischia.  Nevertheless  osteopathic  ex- 
perience has  been  sufficiently  extensive  to  show  that  in 
numerous  cases  there  can  be  an  appreciable  disturbance  in 
the  relation  between  the  bones.  The  most  common  of  these 
consists  in  a  downward  displacement  of  the  sacrum  as  a  whole 
and  a  forward  dipping  of  its  upper  portion.  This  latter  action 
will,  owing  to  the  necessity  from  its  structural  relations, 
cause  a  prominent  posterior  tendency  in  the  lower  half  of  the  sacrum 
including  the  articulation  between  the  sacrum  and  the  coccyx. 
It  is  quite  a  common  matter  to  find  in  the  case  of  the  sacrum 
this  marked  anterior  displacement  of  the  upper  part  and  a 
posterior  lower  displacement.  The  cause  of  this  condition  is 
quite  apparent  in  most  cases — a  strain  of  the  lumbo- sacral 
junction  resulting  in  a  relative  weakness  which  then  permits 
of  a  bending  forward  at  this  point  with  a  consequent  gradual 
forcing  downward  of  the  upper  part.  In  some  cases  one  side 
of  the  sacrum  will  have  yielded  more  than  its  fellow  and  as 
a  result  there  is  a  twisted  condition  of  the  sacrum.  In  occa- 
sional cases  the  opposite  sacral  condition  may  be  noted.  In- 
stead of  the  anterior  dipping  of  the  upper  part  of  the  bone  an 
unduly  straight  condition  is  presented.  This  is  often  asso- 
ciated with  the  typical  straight  spine  and  in  many  cases 
would  seem  to  be  secondary  and  compensatory. 

ADJUSTMENT  OF  PELVIC  STRUCTURES. 

The  treatment  of  pelvic  lesions,  in  so  far  as  it  is  concern- 
ed with  the  sacrum  and  innominate  bones,  is  almost  entirely 
the  adjustment  of  osseous  tissues  with  comparatively  little 
attention  being  paid  to  the  muscle  contracture.  Dr.  Still 
argues  wich  reason  that  in  most  cases  the  treatment  of  sacral 


PELVIC   LESIONS.  347 

and  innominatum  lesions  may  be  simplified  to  one  or  two 
methods  designed  to  make  use  of  the  fact  that  the  sacrum  has 
been  driven  downward  between  the  iliac  structures.  It  is 
manifest  that  if  the  innominate  bones  be  made  immovable 
while  the  body  including  the  sacrum  is  free,  direct  use  of  the 
latter  can  be  made  in  withdrawing  the  wedge-shaped 
sacrum  from  its  bound  condition  by  a  simple  lifting  of  the 
body  from  side  to  side  while  the  innominata  remain  fixed.  It 
is  obvious  that  when  a  wedge  is  driven  into  a  log  it  can  be 
withdrawn  with  much  greater  ease  by  working  it  from  side  to 
side  than  by  exerting  a  straight  simple  traction  force.  That 
is  true  also  with  reference  to  the  sacral  wedge  which  has 
been  driven  downward  into  the  space  between  the  innominata. 
Hence  one  of  the  most  satisfactory  methods  for  overcoming 
the  condition  consists  in  placing  the  patient  in  the  erect 
position  on  a  stool  or  other  hard -bottomed  structure.  Then, 
while  the  ischia  are  held  strongly  against  the  seat  bottom,  the 
patient's  body  is  grasped,  one  hand  is  placed  on  the  iliac  bone 
and  with  a  side-to-side  movement  with  some  rotation  the 
patient  is  literally  lifted  up  from  between  two  of  his  own 
bones.  This  treatment  may  be  used  on  the  chair  specially 
constructed  by  Dr.  Still  but  may  be  used  upon  any  convenient 
stool  or  other  structure  where  the  pelvis  can  be  held  solidly  against 
the  seat.  Further  it  is  equally  applicable  to  all  forms  of  sacral 
and  innominate  disorders.  With  the  innominate  held  im- 
movable any  lateral  to-and-fro  movement  of  t.he  body  which 
acts  upon  the  pelvis  tends  to  release  it  from  its  strained  con- 
dition. 

A  second  method  which  has  long  been  in  use  is  more 
especially  applicable  to  adjustment  of  single  innominatum  le- 
sions. With  the  patient  either  upon  his  side  or  lying  prone 
the  limb  may  be  grasped  in  the  region  of  the  knee  and  drawn 
backward.  This  exerts  a  downward  traction  as  well  as  a  for- 
ward one  upon  the  anterior  portion  of  the  innominate  bone 
through  the  attachment  of  various  muscles  but  more  especi- 
ally the  strong  Y-shaped  ilio  femoral  ligament  which  attaches 


348  PRINCIPLES    OF   OSTEOPATHY. 

below  to  the  great  trochanter  and  anterior  portion  of  the 
femur  by  the  two  limbs  of  the  Y,  and  above  to  the  anterior 
inferior  spine  of  the  ilium.  This  ligament  is  the  structure 
which  normally  prevents  a  hyper- extension  of  the  thigh.  In 
most  cases  a  distinct  resistance  can  easily  be  felt  when  the 
limb  is  drawn  back  beyond  the  straight  line  a  short  distance. 
And  this  point  represents  the  danger  line.  By  this  is  meant 
that  in  making  use  of  this  manipulation  only  a  trifle  more 
pressure  should  be  used  after  that  resistance  is  felt,  since 
there  is  some  danger  of  injury  to  the  structures.  It  is  especi- 
ally needful  that  this  caution  should  be  emphasized  because 
of  the  long  power  arm  and  comparatively  short  weight  arm, 
and  hence  by  its  use  a  powerful  force  can  be  applied.  This 
treatment  of  course  applies  more  especially  to  posterior  and 
upward  luxations  of  the  innominatum  and  to  anterior  condi- 
tions of  the  upper  part  of  the  sacrum,  in  addition  to  its  use 
for  purposes  of  exaggerating  the  lesion.  For  the  opposite  kind 
of  lesion  a  similar  treatment  is  used  but  with  less  powerful 
effect  owing  to  absence  of  the  unyielding  white  fibrous  tissue 
that  is  found  in  the  ilio-femoral  ligament  and  to  the  fact  that 
conditions  permit  of  extreme  flexion  of  the  thigh  upon  the 
abdomen.  In  this  treatment  the  patient  lies  upon  his  side  or 
upon  his  back  while  the  physician  strongly  flexes  the  limb 
upon  the  abdomen,  which  results  in  putting  tension  upon  the 
posterior  thigh  and  iliac  muscles  and  tends  to  draw  the  part 
downward  and  backward.  If  in  addition  to  flexion  and  ex- 
tension of  the  limb  in  these  movements  abduction  be  also  em- 
ployed, additional  effects  will  be  gotten  upon  the  pubic  and 
the  ischiatic  portions  of  the  bone  through  the  adductor  and 
the  postero-internal  thigh  muscles. 

Another  method  in  common  use  is  spoken  of  as  the 
\vheel-and-axle  movement.  "With  the  patient  on  his  side 
and  the  physician  in  front  one  hand  grasps  the  crest  of  the 
ilium  while  the  other  reaches  underneath  the  thigh  and  is 
placed  strongly  upon  the  ischium.  Then  with  the  force  of 
the  two  hands  applied  in  opposite  directions  the  innomina- 


PELVIC   LESIONS.  349 

turn  may  be  rotated  or  lifted  in  any  direction.  In  this  case 
a  double  leverage  is  secured  in  which  the  lever  arms  are  not 
so  long  as  in  the  case  of  the  methods  above  described. 

For  direct  work  upon  the  sacrum  the  knee  may  be  em- 
ployed at  the  prominent  parts  in  either  the  erect  or  horizon- 
tal posture.  Strongly  flexing  the  body  at  the  sacro-lumbar 
articulation  at  the  same  time  exerting  forward  pressure  upon 
the  iliac  bones  will  be  helpful  for  an  anteriorly  receding 
sacrum. 

Where  the  pubic  articulation  shows  a  difference  in 
level  on  the  two  sides,  direct  pressure  here  may  be  advantage- 
ous; but  in  most  cases  the  direct  work  upon  this  part  of  the 
pelvic  structures  is  unsatisfactory. 

LESIONS  OF  THE  COCCYX. 

The  normal  condition  of  the  coccygeal   articulation 

permits  of  considerable  motion  in  an  antero- posterior  direc- 
tion and  an  appreciable  amount  of  lateral  movement.  This 
is  more  true  of  younger  individuals  since  with  increasing  age 
the  parts  tend  to  become  ossified.  In  females  there  is  rela- 
tively more  motion  than  in  males  and  in  case  of  pregnancy 
this  junction  like  that  of  the  pubes  becomes  quite  yielding. 
The  position  of  the  coccyx  should  normally  be  such  as  to  con- 
tinue the  curve  of  the  sacrum.  Departures  from  this  curve 
usually  suggest  an  abnormal  condition. 

The  most  common  subluxation  of  the  coccyx  is  the 
anterior  displacement.  Usually  this  is  but  an  increased  an- 
gularity between  the  sacrum  and  coccyx  or  between  adjacent 
parts  of  the  latter.  If  in  palpation  along  the  course  of  the 
bone  an  abrupt  anterior  bending  is  noted,  it  is  quite  indica- 
tive of  abnormality.  This  will  be  more  certainly  decided  if 
there  is  noticed  soreness  and  contracture  of  the  lateral  struc- 
tures. In  many  cases  there  will  be  a  lateral  subluxation  which 
will  be  easily  determined  by  noting  the  space  on  either  side 
of  the  coccyx.  In  other  though  occasional  instances  the  coc- 
cyx will  be  too  straight  and  hence  constitute  a  posterior  con- 


350  PRINCIPLES    Of   OSTEOPATHY. 

dition.  The  amount  and  nature  of  these  various  lesions  may 
be  further  determined  by  palpation  from  within  the  rectum.  In 
many  cases  the  insertion  of  the  finger  will  be  associated  with 
more  or  less  pain  which  of  itself  is  suggestive  of  disorder.  In 
making  the  examination  some  non- irritating  oil  should  be 
used,  the  nail  of  the  finger  cleaned,  and  soap  or  vaseline  used 
to  thoroughly  fill  up  the  crevice  underneath  the  nail. .  Bear 
in  mind  that  the  canal  of  the  rectum  for  its  first  inch  or  two 
passes  forward  as  well  as  upward  before  bending  backward 
to  follow  the  course  of  the  sacro-coccygeal  curve.  With  the 
finger  thus  inserted  the  tissues  can  be  grasped  between  the 
thumb  and  finger  and  the  exact  postion  of  the  coccyx  more 
accurately  determined.  This  method  need  only  be  resorted 
to  in  occasional  cases.  It  is  never  free  from  the  possibility 
of  producing  harm,  .and  in  most  cases  sufficient  data  for 
judgment  can  be  gained  by  external  palpation. 

As  to  the  treatment  of  coccygeal  lesions  a  few  notes 
with  reference  to  their  cause  are  imperative.  Dr.  Still  has 
made  emphatic  the  statement  that  in  many  cases  the  disorder 
of  the  coscyx  is  secondary  to  sacral  subluxations .  When  that  is 
true  work  upon  the  coccyx  without  reference  to  the  sacral 
condition  will  in  many  cases  be  wasted  effort.  While  it  un- 
doubtedly will  assist  in  overcoming  the  disorder  in  some  in- 
stances it  can  never  permanently  cure  until  the  sacrum  be 
adjusted.  The  coccyx  is  suspended  from  the  sacrum  by  its  ar- 
ticulation and  by  the  sacro-coccygeal  ligaments  and  muscles; 
from  the  innominata  by  fibres  of  the  sacro-occygeal  liga- 
ments passing  from  the  ischia  along  the  lateral  aspects  of  the 
sacrum  to  ultimately  blend  with  the  coccygeal  structures. 
If  the  sacrum  be  driven  downward  or  backward  these  fibres, 
unyielding  in  their  nature,  will  prevent  the  coccyx  from  passing 
with  it,  with  the  result  of  strongly  drawing  the  coccyx  an- 
teriorly. In  other  cases  where  one  side  of  the  sacrum  is 
more  markedly  involved  a  lateral  condition  of  the  coccyx  will 
also  result.  In  cases  of  this  kind,  while  it  is  the  coccyx  that 
seems  to  be  disturbed,  in  reality  it  is  the  sacrum  and  hence 


CGLLIEfcE  GF  GSTEGf 
FK"'~  f  Of  £  ff  £-£'. 

PELVIC   LESOINS.  351 

the  treatment  must  be  applied  to  the  latter  rather  than  to  the 
former. 

In  other  cases  the  coccyx  alone  may  be  disordered. 
Such  will  depend  on  direct  violence  as  in  falling  and  striking 
the  part  or  from  direct  blow  otherwise.  Undoubtedly  many 
a  luxated  coccyx  has  resulted  directly  from  the  abominable 
practice  indulged  in  by  boys  and  young  men,  of  using  the 
toe  of  the  boot  in  this  region  when  engaged  in  various  forms- 
of  sport.  In  addition  occasional  cases  may  result  from 
muscular  contracture  of  the  associated  tissues  dependent  upon 
some  irritation  to  the  muscle  or  its  nerve  mechanism  In 
these  primary  subluxations  direct  treatment  to  the  coccygeal 
tissues  will  be  necessary.  Usually  enough  pressure  can  be 
gotten  by  external  manipulation  to  effect  adjustment  but  oc- 
casionally internal  treatment  may  be  necessary.  With  finger 
inserted  as  above  described  the  coccyx  may  be  grasped  and 
quietly  but  strongly  lifted  backward  toward  its  normal  posi- 
tion. In  such  treatment  it  is  an  almost  invariable  rule  that  the 
frequency  should  not  be  greater  than  once  in  a  week,  while 
in  most  cases  once  in  two  weeks  willbe  all  that  is  permissible. 

EFFECTS  OF  PELVIC  LESIONS. 

Effects  of  pelvic  lesions  have  already  been  suggested  in 
large  part.  The  only  considerable  possibility  of  disorder  from 
direct  pressure  of  a  luxated  structure  is  in  connection  with 
the  coccyx,  which  may  by  an  anterior  condition  exert  direct 
pressure  upon  the  posterior  wall  of  the  rectum  and  the  external 
and  internal  sphincter  muscles.  In  this  way  there  may  result 
various  disorders  of  the  lower  bowel.  Occasional  cases  of 
this  form  of  lesion  seem  to  offer  a  direct  obstruction  to  the 
passage  of  the  f  eces  but  in  most  of  these  there  will  also  be  a 
local  exhaustion  of  the  nerve  force  to  account  for  the  lessened 
activity.  Disordered  condition  of  the  sphincter  muscles  in  the 
way  of  undue  contractures  or  atonic  conditions  are  met  with. 
These  appear  to  depend  upon  the  continual  irritation  pro- 
duced by  the  luxated  coccyx.  The  same  condition  of  coccy- 


352  PRINCIPLES   OF  OSTEOPATHY. 

geal  lesion  or  other  disturbances  of  the  pelvic  bones  which 
limit  the  diameters  of  the  pelvis  may  offer  serious  obstacle  to 
the  expulsion  of  the  fetus  at  parturition. 

The  vessels  which  are  likely  to  be  involved  in  impinge- 
ment are  relatively  few  and  unimportant.  Various  branches 
of  the  internal  iliac  arteries  which  pass  to  supply  the  spinal 
muscles  may  be  pressed  upon  by  contractured  tissues.  The 
sacral  portion  of  the  spinal  canal  receives  filaments  from  the 
lateral  sacral  arteries  which  lie  anterior  and  internal  to  the  row 
of  anterior  sacral  foramina.  These  arteries  give  off  branches 
which  pass  into  the  anterior  and  out  of  the  posterior  sacral  foramina 
giving  off  as  they  pass,  divisions  to  supply  the  sacral  canal 
and  passing  beyond  the  canal  are  distributed  to  the  posterior 
sacral  tissues.  In  various  situations  these  vessels  may  be  im- 
paired in  their  carrying  powers  and  produce  disorder  of  the 
tissues  with  which  they  are  associated. 

EFFECTS  ON  NERVES. 

The  nerves  subject  to  disorder  from  pelvic  lesion  are  the 
spinal  and  sympathetic.  The  sacral  plexus  of  nerves  lies 
in  front  of  the  sacrum  on  the  anterior  surface  of  the  pyrifor- 
mis  muscle  from  whence  it  passes  out  of  the  pelvic  region 
through  the  sacro'- sciatic  foramen  where  it  is  continued  as 
the  sciatic  and  pudic  nerves.  In  this  region  and  where  the 
nerves  forming  the  plexus  have  their  exit  from  the  spinal 
canal,  there  is  possibility  of  irritation  owing  to  associated 
muscular  and  connective  tissue.  The  sciatic  nerve  passing  on 
throughout  the  length  of  the  leg  is  distributed  to  muscular, 
cutaneous,  and  vascular  structures  in  its  various  areas  of 
distribution.  Numerous  kinds  of  disorders  of  the  limb  in  any 
of  its  parts  are  known  to  result  from  sacral  and  coccygeal 
lesions.  Vaso-motor  disturbances,  secretory  abnormalities, 
and  sensory  perversions  are  common  accompaniments  of  the 
sacral  lesion  owing  to  the  presence  in  the  nerve  of  fibres  of 
the  spinal  system  and  of  the  sympathetic  as  well.  An  almost 
endless  number  of  cases  of  sciatica  have  been  shown  to  be 


PELVIC   LESIONS. 


353 


due  to  some  form  of  sacral  orinnominatum  lesion.  Edematous 
tissues  and  varicose  conditions  partly  due  to  contracture  of 
muscle  and  fascia  overlying  the  saphenous  and  other,  veins 
and  partly  dependent  upon  irritation  to  the  nerve  mechanism 
of  the  vessels,  are  often  found  to  be  dependent  upon  pelvic 
disorder. 

The  sacral  spinal  nerves  are  of  more  than  usual  in- 
terest from  the  fact  that  they  are  both  somatic  and  visceral, 
being  supplied  to  various  parts  of  the  organs  of  generation. 
The  same  branches  that  form  the  pudic  nerve  which  supply 
the  more  superficial  tissues  of  the  generative  organs,  give  off 
filaments  that  pass  directly  into  the  pelvic  plexuses  and  are 
the  representatives  in  this  region  of  the  white  rami  of  the  sym- 
pathetic in  other  parts  of  the  spine. 

The  pelvic  plexuses,    two  in    number,    represent  the 


-L 


Vig.   32. — Showing  innervation   of  pelvic  structures. 

centers  for  distribution  of  nerve  influence,    both   spinal  and 


354  PRINCIPLES    OF   OSTEOPATHY. 

sympathetic,  for  the  pelvic  structures.  These  plexuses  are 
formed  from  descending  branches  from  the  hypogastric  plex- 
us, from  branches  direct  from  the  sacral  ganglia,  and  from 
the  spinal  branches  referred  to  above.  From  these  plexuses 
the  various  pelvic  organs  are  supplied  with  secondary  plexus- 
es. Disturbance  therefore  of  the  plexus  through  spinal  or 
sacral  lesion  may  produce  any  one  or  more  of  a  number  of 
effects.  Motor  and  inhibitory  fibres  pass  by  way  of  the  sacral 
nerves  to  reach  the  rectal  wall.  Interference  with  these  will 
produce  perverted  activities  in  the  movement  of  that  part  of 
the  intestine.  In  many  cases  on  examining  the  rectal  walls 
they  will  be  found  in  a  marked  atonic  condition.  This  is  usual- 
ly indicative  of  a  condition  of  exhaustion  of  the  nerve  force 
that  is  normally  distributed  to  that  part.  On  the  other  hand 
in  some  cases  we  find  a  hypertonic  condition  which  is  suggestive 
of  a  more  recent  lesion  which  is  producing  an  excitement  of 
the  local  nerve  mechanism. 

Motor  fibres  to  the  bladder  are  also  associated  with  the 
plexus.  These  are  not  only  concerned  with  the  rhythmic 
action  of  the  bladder  wall  and  with  the  expulsive  action  in 
micturition,  but  are  also  concerned  in  keeping  up  the  tonic 
condition  of  the  sphincter  of  the  bladder.  Hence  irritation  to 
these  structures  may  produce  too  frequent  discharge  or  a 
retention  or  incontinence  of  urine.  By  way  of  the  sacral 
nerves  afferent  fibres  pass  to  the  micturition  center  in  the  lum- 
bar region.  This  center  is  concerned  in  sending  out  motor 
and  inhibitory  impulses  and  in  conjunction  with  the  afferent 
and  efferent  pathways  constitutes  the  reflex  mechanism  for 
micturition.  Lesions  to  the  pelvic  structures  may  reasonably 
produce  impairment  of  one  or  more  of  the  essential  parts  in 
this  reflex.  Vaso-motor  influences  are  probably  regulated 
through  these  plexuses,  and  hence  disorders  dependent  on 
disturbed  blood  supply  are  common. 

Uterine  disorders  may  result.  These  are  dependent 
upon  the  important  nerve  supply  to  the  uterus  received  from 
the  pelvic  plexuses.  Motor  fibres  and  perhaps  vaso-motor  are 


PELVIC   LESIONS.  355 

distributed  thereto,  keeping  the  organ  in  its  normal  state  of 
tone,  and  in  addition  maintaining  the  closed  condition  of  the 
cervix.  The  integrity  of  this  mechanism  becomes  of  supreme 
importance  in  the  pregnant  state.  Lesions  to  these  parts  have 
been  known  to  produce  abortion.  Osteopathic  experience  as 
well  as  anatomic  and  physiologic  experiment  would  seem  to 
indicate  that  tonic  influences  were  continually  sent  to  the 
cervix  of  the  uterus  by  way  of  the  sacral  spinal  nerves,  hence 
lesion  to  the  latter  will  reasonably  lessen  the  resisting  power 
of  the  muscle  tissue  in  the  cervix. 

Disorders  of  the  external  organs  of  generation  may 
result  because  of  the  fact  that  through  the  sacral  branches 
va  so -motor  fibres  are  carried  to  the  vessels  that  supply  those 
structures.  In  the  case  of  the  male  the  fibres  further  furnish 
influences  of  a  secretory  as  well  asvaso-motor  nature  to  the 
prostate  gland.  This  latter  structure  is  quite  often  found  to  be 
more  or  less  markedly  disordered  especially  in  elderly  men. 
The  disorder  is  usually  an  enlargement  of  the  gland.  This 
may  be  sufficient  not  only  to  keep  up  a  continual  irritation  to 
the  afferent  nerve  terminals  and  hence  be  concerned  with  .  a 
general  nervous  condition  but  often  will  be  sufficient  to  offer  me- 
chanical obstruction  to  the  passage  of  the  urine  through  the 
prostatic  portion  of  the  urethra.  A  few  cases  are  on  record 
in  which  a  considerable  retention  of  urine  was  a  direct  result 
of  such  enlargement  and  obstruction. 

A  discussion  of  the  numerous  secondary  disorders 
that  are  associated  with  the  prolapses  and  other  disorders  of 
the  pelvic  viscera  which  in  turn  are  dependent  on  the  various 
lesions  above  described  would  lead  us  too  far  afield.  Hence 
with  this  brief  reference  the  subject  is  left  to  the  special  ef- 
forts of  the  gynecologist. 


INDEX. 


Abbott,  on  germ  theory,  94,  96 
Abdominal  Organs,  disorders  of.  330. 

336 
Abuse,  as  cause  of  disease,  88 

exhaustion  from.  89 

from  excesses.  36 

overuse  as,  89 

perverted   use  as,  91 

treatment  of,  155 

under  use  as,  90 
Accelerators,  of  heart,    79,   212,   223, 

263,  312 

Acid,  as  stimulus  to  contracture,   87. 
Aconite,  ais  sedative,  166 
Acute  Cases,   frequency   of  treatment 

in,  100 

self  cure  in,  74,  88 
Adaptation,  in  tendency   to   normal, 

<;o 

power  of,  159 

Adhesion,  treatment  of,  187 
Adjustment,  continuous  during  life,  24 

forces  concerned  in, 67 

of  osseous  lesions,  126 

of  muscle  to  function,  37 

of  muscular  lesions,  129 

of  pelvis,  346 

possibilities,  81 

rib,  296 

self,  22 

structural,  26,  35 
Age,  as  predisposition,  92 
Albuminuria,   as   objective  symptom, 

106 

cause  of,  7O 
Alcohol,  Brunton   on,   165 

in  patent  medicines,   173 
American  Medicine,  on  drugs,  170 
Amplitude  of  Movement,  in  diagnosis. 

119,  283 

Anabolism,  of  cell,  35 
Anderson,  on  crossed  innervation,  143 
Anemia,  cause  of,  334 

iron   in   40.  167 

Aneurism,  from  blood  pressure,  90. 
Angina  Pectoris.  cause  of,  263,  329. 
Ankylosis,  119,  151 
Anorexia,  as  protection,  103 
Ante-cellular  Elements,  28 
Antiquity,  medical  practice  in,  12 
Antiseptic,  in  blood,  36 
Antitoxin,  31 .  35 

in  blood.  36 
Aorta,  187 

affected  by  lesions,  313,  335 
Apoplexy,  from  blood  pressure,  9O 
Appendicitis,  treatment  of,  186 
Appetite,  as  guide  in  diet,  59 
Aristotle,  pneunia  theorv  of,  13 
Arm,  lesions  affecting,  314,  333 
Arsenic,  as  remedy,  41, 

habit,  170 


Art,  versus  science,  10 
Arterio-sclerosis,  92 
Artery,  carotid,  247 

intervertebral,  78,  204,  250,  308 

renal,  78 

subclavian,  314 

thyroid,  251 

vertebral,  249 
Asthma,  cause  of,   316. 

frequency    of  treatment  in, 160 

shape  of  chest  in,  285 
Astringents,  167 
Atavism,  definition  of,  66 
Atlas,  examination  of,  236 

relation  to  cranial  nerves,  255 

relation  to  vertebral  artery,  249 

treatment  of,  241 
Atmosphere.as  predisposing  occasion, 

92 
Atrophy,  from  abuse,  90 

massage  for,  186 
Attitude,  in  diagnosis,  110 
Atwater.  on  value  of  foods,  57 
Auscultation,  in  diagnosis,  108 
Auto-toxins,  32 
Axis,  examination  of,  238 

of  rotation  of  ilium,  340,  342 

of  rotation  of  ribs,  287 

B 

Bacillus,  Klebs-Loeffler,  96 

of  Koch,  96 

Bacon,  on  massage,  182 
Bacteria,  as  cause  of  disease,   95 

excreta  from  as  stimulus,  73 

in  lagrippe.  33 

products  of,  35 

relation  to  abuse,  91 

saprophytic  and   pathogenic,  95 

tenacity  of  life,  168 

vitiated  tissue  necessary  for,    99 
Basch,  innervation  theory  of.  322 
Bath,  uses  of,   178 
Bitters,  stimulating,  166 
Bladder,  disorders  of.  326 

nerves  of,  354 

vaso-motors  of,  216,  354 
Booth,  on  summation  of. causes,  94 
Borborygmus,  108 

Borrellf,  on  animal  movement,  15,  37 
Boundaries,  of  osteopathy,  20 
Bradycardia,  cause  of,  330 
Brahmins,  on  urinalysis,  12 
Bridges,  protoplasmic,  24,  29 
Bright's  Disease,  80,  217 
Bronchitis,  316 
Brunton,  on  alcohol,  165 
Buzzards,  Dr.  Still  on,  95 


Cancer,  cure  of,  334, 

Roentgen  rays  on,  176 


358 


PRINCIPLES   OF   OSTEOPATHY. 


Capillary  Attraction,  as  force  in  func- 
tion, 37 

Carbohydrates,  food  value  of.  54 
Carbon,  essential  to  protoplasm,  39 

oxide  of  as  normal  stimulus,  141 

oxid  of  in  blood,  40,  ss 
Cartilage,  connection  between  cells  of, 

29 

costal,  302 

thyroid,  232 
Cathartic,  use  of,  148 
Catarrh,  of  throat,  232 

treatment  by  massage,  187 
Caucasian,  predisposition  in,  93 
Cause  of  Disease,  abnormal  structure 

as,  69 

abuse  as.  88 

in  cell.  32 

micro-organism  as,  17 

Predisposing   and     exciting,    91, 
22 

removal  of,  for  relaxation,  131 

reversibility  of,  93 

revolution  in,  18 
Cell,  cause  of  disease  not  in,  32 

insufficiency  of  doctrine,  27 

Virchow's  influence  on  doctrine, 

16 
Center,  micturition,  354 

osteopathic  for  stomach,  319 

YRBO-motor,  215 
Cervical  Region,   effects  of  lesions   in, 

246 
Chair.  Dr.  Still's,  275.  299 

examination  of,  202,  2(5 
Change,  law  of.  25.  43 
Chemical  Laboratory,  body  a,  38,  67 
Chemotaxis,  68 
Chest,  as  a  whole,  110,  283,  296,  301 

barrel-shaped,  2S5 

box-shaped,  286 

disorders  of.  334 

flat,  284,  328 

tapering,  285 
Chill,  as  symptom,  102 
Chinese,  diet  of,  57 

medical  practice  of,  12 

on  massasre,  182 
Cholera,  asiatica,   96 

morbus,  92 

Chloral,  addiction,  170 
Chloroform,  addiction.  170 
Christian  Science,  17,  179 
Circulation,  discovery  of,  15 

massage  on,  186 

self-regulation  of,  60 
Cirrhosis,  of  liver.  78 

treatment  of,    1  38 

Clavicle,  diagnosis  and,treatment,304 
Climate,  as  predisposing  occasion,  92, 

93 

Clothing,  as  cause  of  lesion,  294 
Cocaiu,  as  sedative,  166 

habit,    170 
Coccyx,  lesions  of,  349 

treatment  of,  35O 
Colic,  ovarian,  324 

renal,  325 

treatment  for,  142 
Color,  in  diagnosis,  120,  291 
Comparison,  in   diagnosis,   108,    116, 

197,  226.  340,  344 


with  other  systems,  164,  190 
Compensation,  from  functional  change 

in  spinal  curves,  196 

in  structural  change,  <'>:; 
Constipation,  152 

cause  of.  321,322,  331 

water  in,  178 

Consumption,  pulmonary,  328 
Continuity  of  Protoplasm.  2!» 
Con  tract  u  re,  as  evidence  of  lesion,  117 

as  lesion,  77,  2()1,  219 

causing  rigid  spine,   195 

distinguished  from    contraction, 

118, 133 

idiomuscular,  117 

of  rib  muscles,  29O 

secondary,  75,  222,  224 
Control    of    Function,    difficulty      in 

direct,  143 

indications  for  direct.  15O 

objections  to  direct,   147 
Convulsions,  a  normal   process,  62 

Dr.  Still  on,  1O2 
Corpuscle,   continuity    of  protoplasm 

in  white,  30 

red,  in  anemia,  40,  167,  334 

spherical  shape  of  white,  :'.'.» 

white,  in  infection,  62 
Cramp,  writer's,  155 
Crepitus,  in  rib  cartilages,  2'.i5 
Crothers,  on  drug  habits.  169 
Croup,  temperature  in,  1  L'U 

treatment  of,  151 
Curvatures  of  Spine,  194.  27!» 

compensatory,   196,  :',4o 

diagnosis  of,  197 

lateral,  196,  269,  340 

posterior.  273 

rotation  of  vertebrae  in.  196 
Cytoplasm,  as  specialized  protoplasm, 

28 

D 

Definition,  of  lesion,  75 

of  life,  22 

of  machine,  36 

of  osteopathy,  2O 
Deposits,  as  lesion,  1 19 

of  pigment,  120 
Depressor,  nerve,  61 
Descarteg,  on  man  a  machine,  1  5 
Diabetes  Mellitus,  cause  of,  32<> 
Diagnosis,  an  object  in  relaxation,  129 

of  disease,  101 

of  lesions,  109 

Diaphragm,  disorders  from,  335 
Diarrhoea,  as  symptom,  103 

cause  of,  322,  331. 

from  muscle  contracture,  I'l'O. 

treatment  of,  152 
Diet,  disease  from  errors  in.  122 

essentials  in,  56 

treatment  by,  167 
Diffusion,  of  body  fluids.  37,  45 
Digitalis.  166,  169 
Diphtheria,     baccillus     of    in   normal 

individual.  96 
Disease,caused  by  micro-organisms,!  7 

caused  by  structural  disorder,25 

cause  of  not  in  cell,  32 


INDEX. 


359 


definition  of,  69 

diagnosis  of,  101 

entity,  164 

maintained  by  structure,  72 

sett-regulation  in.  <>1 

treatment  of.  121.  15." 
Dislocation,  definition  of,  76 
Displacement,  definition  of,  76 
Doctrine,  cell,  16.27 

of  spirits,  13 
Drugs,  as  abuse  of  function,  91 

as  germicide,  168 

as  placebo,  164 

combat  effects,  168 

cumulation  of,  169 

deleterious   effect  of,  31 

desertion  of,  17 

elimination  of,  169 

for  neutralising,  167 

habit,  169 

poisoning  by,  169 

results  of  treatment  bv,  168 

sedative  action  of,  166 

stimulant  action  of,  166, 169 

therapy.  164 

treatment  safer  than,  162 

uncertainty  of,  173 

E 

Ear,  ache,  115,  245 

lesions  affecting,  262 

vaso-motors  of,  262,  312 
Eczema,  cause  of,  315 
Effects,  combatting,  18,  168 

of  cervical  lesions,  245 

of  inferior  maxillary  lesions,  246 

of  p"lvir,  lesions,  351 

of  thoracic   and   lumbar  lesions, 

308. 

Effleurage,  184 
Egyptians,  on  massage,  182 
Electricity,  currents  of  in   muscle,   16, 

49 

in  relation  to  disease,  174 
Electrotherapy,  basis  for,  176 

practice  of,  145, 174 

rise  of,  1* 
Electrotonous.l  74 
Kmphysema,  285 
Empirical  Method,  165 
Enema,  value  of.  179 
Energy,  chemical.  44 

conservation  of,  43 

diairram  of.  52 

definition  of,  43 

"let-trie,  48 

gravitation,  45 

health,  as  co-ordniation  of,  51 

kinetic,  versus  potential,  5() 

mechanical.  46 

molecular  45 

nervous,  49 

of  body,  43 

photic,  47 

thermal,  47 

transformation  of,  44 

Van  Helmont  on  matter  and,  15 

vital,  26,  44 

Enteroptosis,  cause  of,  331 
Epithelium,  connection  between   cells 

of,  29 


Equilibrium,  moving,  25 

of  spine,  19<i 

Esophagus,  in  vomiting,  147 
Esquimaux,  diet  of,  57 
Ether,  habit.  17O 
Etiology,  of  disease,  69,  88 
Evolution,  of  osteopathy,  12 

theory  of,  1  3 
Exaggeration  of  Lesion, 127,  135,240, 

297,  300,  348 
Examination,  methods  of,  106 

of  cervical  vertebra?,  234 

of  inferior  maxillary,  243 

of  pelvis,  339 

position  for,  20O 

of  ribs,  282,  294 
Excesses,  as  cause  of  disease,  36 
Exostoses,  treatment  of,  137 
Eye,  disorders  of,  156 

effects  on  through  nerves,  261 

treatment  of  by  massage,  187 

vaso-motors  of,  262,  312 


Fainting,  187 

Fasting,  as  therapeutic  measure,  59 

Fat,  function  of.  54 

in  protoplasm,  39 
Fatigue,  as  cause  of  contracture,  87 

cause  of,  33 

of  muscle,  117 

overcome  by  rest,  35 
Fauces,  affected  by  lesions,  262 
Fenestra  Kotundum,  37 
Ferments,  doctrine  of,  15 

I'asteur  on.  17 
Fever,  hay,  92,  122 

scarlet,  92 

tvphoid,  93 

yellow,  93,  97 
Fibrin,  in  hemorrhage,  41 
Filtration,  in  body  functioning,  37,45 
Foodstuffs,  formation  of,  48 

organic,  53 

pre-digested,  9O 

value  of    54 
Force,  back  of  tendency  to  normal,  65 

external,  necessary  in  treatment, 

2* 

organizing,  26 

sufficient  to  reduce  lesion,  162 

vital,  16,  23,  53,59 
Friction,  in  massage,  184,  186 
Fuel,  body,  53 
Function,  abuse  of  88,  180 

artificially  changed,  146,  165 

n-lation  between   structure  and 

18,  22,  25,  145,  147 
Furrow,  median,  200,  277 

G 

Galen,  circulation  suggested  by,  15 

influence  of.  14 

on  mechanotherapy,  182. 
Gall  Stones,  1  34 

Galvani,  on  electricity   in  muscle,  16 
Ganglion,  cervical.  258.  312 

(iasserinn.  254,  259 

connection    with    spinal  nerve's, 

208 


360 


PRINCIPLES   OF   OSTEOPATHY. 


middle  and  inferior  cervical,  260 

superior  cervical,  258 

sympathetic,  2O7,  312 
Gangrene,  cause  of,  70 
Gaskell,  on  cardiac  muscle.  29 
Gastritis,  cause  of,  318 

treatment  by  massage,  186 
Generation,  spontaneous.  15 

tender  areas  in  organs  of,  188 

vaso-motors  of  organs   of,   2KJ, 

327,  355 
Germ, blood  in  relation  to  pathogenic, 

36 

effects  of  drugs  on,  168 

heredity   in  relation   to  cells,  32 

theory,  15,  94 
Gland,  ductless,  167 

mammary,  78,333,  334 

prostate,  355 

thyroid,  167,  233,  247,  263,  333 
Glisson*  on  irritability,  16 
Glycogen,  as  reserve  food,  56 
Glycosuria,  as  symptom,  104 
Goitre,  233,  251,  263,  333 
Goltz,  on  inhibition  of  heart,  146 
Greeks,  on  massage,  182 
GriniieH,  on  drug  habits,  170 
Growth,  all  sciences  result  of,  20 

changes  in, constituting  lesion. 77 

function  and  structure  in  rehation 

to.  26 

reverse,  160 

H 

Habit   drug,  1  69 

treatment,  149,  185 
Hemoglobin,  in  anemia,  40 
Hiemorrhage,  fibrin  in,  41 

treatment  of,  151 
Hahnemann,  16 
Haller,  on  Irritability  and   vital  force, 

16 

Hart,  theory  of,  222,  251 
Harvey,  discovery  of  circulation,  15 
Hayem.  on  electrotherapy,  174 
Head,  law  of,  87,  113,  114 

vaso-motor  of.  216 
Headache,  bilious,  84 

from  irritation  to  nerves,  252 

from  contractures,  134 

treatment  of,  150,  230,  332 
Healing,  Svdenham  on  power  of,  16 
Health,  definition  of,  69 
Heart,  action  of.   147 

connection  between  cells  of,  29 

disorders  of  noted  by   ausculta- 
tion, 108 

effects  of  cervical   lesions  on,  262 

effect  of  thoracic   lesion   on,  313, 

329,  332 

treatment  for,  151 

vaso-motors  of,  216 
Heat,  from  chemical  action,  45,  47 

level  maintained,  47 
Hebrews,  influence  on  medicine,  13 
Heredity, factor  in  tendency  to  normal, 

65 

Hiccough,  treatment  of,  142,  187 
Hill,  on"  cerebral  circulation,  70 
Hilton,  on  innervation,  115 

on  pain,  82 


on  surgery,  17 
Hip,  examination  of,  109 

referred  pain  in,  115 

nerves  of,  3()9,  311 
Hippocrates,  influence  on  medicine,  13 

on  massage.  1S2 
Hoffman,  on  massage,  182 
H  olden,  on  median  furrow,  277 

on  torsion,  198 
Hulett,  on  metabolism,  .">." 
Hydrodynamics,  of  body,  37 
Hydrotnerapy,  as  sedative  agent,  178 

as  stimulant  measure,  177 

as  thermal  agent,  177 

rise  of,   18 
Hygiene,  as  prophylactic,  121 

of  Hebrews,  13 
Hyoid,  231 
Hypertrophy,  from  overuse,  89 

of  heart,  104 
Hypothesis,  working,  11 


latrochemical  school,  15 
latromechanical  school,  15 
Ilio-costal  Space,  295 
Ilium,  subluxations  of.  340 
Immunity,  forms  of.  9(» 

natural  and  acquired.  41 
Incontinence,  of  urine,  320 
Inferior  Maxillary, examination  of,  243 

lesions  and  treatment  of,  2  I  I 
Inflammation,  119, 

from  lesions  to  vaso-motors.  I'll. 
Inheritance,  of  disease,  32 
Inhibition.  140,  155 

artificial,  142 

as  function  of  nervous  system, 220 

definition  of,  141 

diagram  of  theory  of,  149 

final  result  of  lesion,  219 

natural,  141 

of  phrenic.  144 

possible  uses  of,  141 
Innomlnatum,  subluxated,  294,  340 
Inspection,  examination    of  spine   bv, 

266 

definition  of,  106 
Intercostal,  nerves,  (>1,    309.  316    .".37. 

spaces  in  diagnosis.  Ill 

vessels,  :'..".  1 

Internal  Secretions, relation  to  organo- 
therapy,  18 

relation  to  protoplasmic   contin- 
uity, 3-1 
Intestines,  disorders  of,  321.  331 

vaso-motors  of,  216,  321 
Iron,  in  amentia.  40 
Irritability,  Haller  and  Glisson    on,  16 


.Tacoby,  on  electrotherapy,  li  5 
Jaundice,  cause  of,  320 

K 

Katabolism,   influenced    bv    massage, 
185 

in  heart  muscle,  148 
products  of  cause  disease,  33,  35 


INDEX. 


361 


prodiirts  of  ,-is  stimulus   to   cure, 

Kellgivn,  on  summary  of  massage,188 

on  Swedish  movements,  isi 

on  treatment  of   pneumogastric, 

187 
Kidnev.  disorders  of,  325 

floating.  7S.  331 

stimulation  of,  150 

vaso-motors  of,  210 
Klebs.  on  bacteria  in  disease.  17,  94 
Kleeii,  on  circulation,  180,  187 

on  niechanotherapy,  183 
Kneading,  in  massage,  185 
Koch,  bacillus  of,  9(5 

on  bacteria  in  disease,  17,94 
Krukenberg,  on  medical  art,  17 

on  organism  as  a  whole,  24 


Laboratory,  body  a  chemical,  38 
Lactose,  source  of,  42 
Ladd,  on  definition  of  a  science,  20 
Lagrippe,  bacillus  of   33 
Landmarks,  in  diagnosis,  111,  199 

pelvic,  339 

rib.  2S(5 

sternomastoid  as,  227 

thyroid  cartilage  as,  232 
Langley,  on  crossed   innervation,  143, 

323 
Law,  general  physiological,  220 

Head's,  87,  U3 

of  change.  25 

Khysical   and   chemical,   basic  in 
inction,  24,  30.  37 
Lesion,  adjustment  of  osseous,  126 

"    muscular,  129 
causes  of,  84 
cervical,  226 
costal.  282 
definition  of,  75 
diagnosis  of,  109 
exaggeration  of,  127 
extent  of,  80 
first  evidence  of,  110 
general  thoracic  and  lumbar,  266 
•JS4 
local  thoracic  and   lumbar,   276, 

L>S<» 

lumbar,  277.  308 
not  apparent,  150 
not  entirely  removed,  159 
not  Immediately  removed,  1  57 
not  in  all  structural   changes,  111 
pelvic.  33S,  351 
predisposing,  150 
producing  stimulation,  145 
removal  of  In  stimulation,  155 
relation  of  protoplasmic  contin- 
uity to.  31 

relation  of  heredity  and   adapta- 
tion to,  0(5 
sacral,  345 
secondary.  89,  150 
slight  in  extent,  2O1 
stimulation  after  removal  of,  150 
thickened  ligaments  as.  27O 
treatment  of  other  than  bony, 137 
varieties,  76 


v  a  so-motor    disturbances  from, 

Lever,  principle  of  in  body,  30 
Life,  definition  of,  22 

elementary  units  of,  28 

viewpoint  of,  22 
Ligament,  as  lesion.  270 

ilio-femoral,  :+47 

nut'ho*.  2i  0.  230 

supra-spinous,  200 
Light,  definition  of,  47 

cure,  48 
Limbs,  disorders  of,  310,  328 

length  of,  313,  344 

vaso-motors  of,  216 
Ling,  on  niechanotherapy,  183 

Swedish  movements  established 

by.  16 
Liver,  diagnosis  of  disorder  of.lll 

glycosuria  in  disorder  of.  1(4 

stimulation  of,  H2.  15n.  15;,  168 

vaso-motors  of,  216,  H19 
Lombard,  on  irritability  of  muscle.134 
Lowy,  on  heat  fnmi  metabolism,  102 
Lumbar,  lesions,  277 

fifth,  280 

vessels,  3C9 
Lung,  disorders  of.  220,315,  328 

tender  areas  in  disorders  of,  188 

under  use  of,  s-0 

vaso-motors  of  216.  315 
Lymph,  pressure  on  channels,  78,  333 
Lymphatic   System,  effects  of  lesions 

on,  205 

M 

Machine,  man  a.  15,  36,  59,  69 
Macrocosm,  nature  a,  14 
Malaria,  97 

Mammary  Gland.  78,  :«3.  334,  337 
Marey,  on  animal  movement,  15,  37 

on  function  versus  structure,  26 
Massage,  beauty,  relation  to,  182 

countries  where  practiced,  183 

definition  of,  181 

history  of,  1 82 

technique  in.  184 
Mastication,  abuse  of.  91 
Matter,  and  energy,  15,  23,  43 
McGregor-Robertson,    on  electrother- 
apy, 174 

Mechanism,  body  a,  38 
Mechanotherapy,  181 

difference    between     osteopathy 

and,  188 

Media,  for  effects  from  lesions,  77 
Medical  News,    on  patent  medicines 

K2 
Medicine,  history  of,  12 

patent.  173 

prophylaxis  a  part  of.  121 
Medulla.centers  of  in  relation  to  cervi- 
cal lesion.  230,  253,  264 
Meltzer,  on  effect  of  drugs.  173 

on  protection  from  bacteria,  97 
Mensuration,  108 
Metabolism,  finer  processes  of,  55 
.  in  disease.  32 

in  fever,  62 
Metclmikoff,  on  phagocytosis,  97 


362 


PRINCIPLES   OF   OSTEOPATHY. 


Meyer,  on  syncytium,  30 
Microcosm,  man  a.  14 
Micro-orgjuiism,  destruction  of,  193 

protection  against  97,  178 

relation  to  disease.  17,  33 

Roentgen  ray  on,  176 

temperature  effect  on,  62 
Microscope,  invention  of,  15 
Mind.  Christian  Science  on,  17,  179 

Descartes  on,  15 

Still  on.  -23 

Molecular  Attraction,  45 
Monell,  on  electrotherapy,  174 
Morphine  for  pain,  148 

stimulant  effect  of,  166 

use  of  resulting  in  habit,  170 
Movement,  amoeboid.  28 

amplitude  of  in  diagnosis,  119,  283 

method  of  in  treatment,  162 

muscular  asliberator  of  energy  ,47 

normal  rib,  287 

pivot,  of  rib,  287 

principles  back  of,  240 

rapidity  of  in  treatment,  161 

Swedish,  16, 183 

Mucous  Membrane,   self-cleansing,  179 
Muscle,  action  of  affects  bone,  26 

an  tic  us  major,  258 

biceps,  87 

continuity  of  protoplasm  in,  30 

contraction  wave  in,  29 

fatigue.  33 

leverages  in,  86 

peroneus,  S7 

posterior  of  neck,  229 

psoas,  809,  310 

pyriformis,  78,112 

scaleni,  136,  228,  291,  300 

sense  in  diagnosis,  198 

sternomastoid,  109,  227,  257 

trapezius,  257 

tone  of,  843 

treatment  of,  129, 137, 151 

N 

Nancrede,  on  gangrene,  70 
Nature,  a  macrocosm,  14 

attempts  at  adjustment,  158 

a  unit,  U 

never  complete,  14 

Sydenhiun,  on  healing  power,  18 
Negro,  immunity  of,  93.  9fi 

race  as  predisposing  factor,  93 
Nephritis,  81 

Nerve,    afferent    function    of  sympa- 
thetic, 212 

anterior  crural.  811 

cranial,  effects  on,254 

depressor.  61,  215 

external  cutaneous,  311 

facial,  254 

fifth  cranial,  254 

function  of  not  known,  143 

glosso-pharyngeal,  255 

hypoglossal,  258 

intercostal,  82 

massage  of.  187 

obturator,  311 

phrenic,  Gl,  142.  144,  234,  253,  337 

pressure  on,  78 

pudic,  311 


sacral.  143,  J52 

sciatic,  112,  154,  311,  352 

secretory,  of  sympathetic, 212 

spinal,  205,  251,  30»,  353 

spinal  accessory,  144,  257 

splanchnic,  317 

stimulation,  of  splanchnics,  144 

sympathetic,  206,  258.  312,  337 

ulnar,  82 

vagus,  255 

vaso-motor,  214 
Nervl-nervorum,  205 
Neuralgia,  facial,  245,  254 

intercostal,  309,  837 
Neuritis.  311 

Neutralization,  drugs  given  for,  167,192 
Nitrogen,  importance  of,  24,  39 
Normal,  definition  of,  67 

tendency  to,  64 

Nucleus,  relation  of  cytoplasm  to,  28 
Nutrition,  disturbance,  85,  337 

o 

Obstruction,  vascular,  247,  308 

Opium,  as  sedative,  166,  169 

Organism,  as  a  whole,  17,  21 

cure,  the  prerogative  of.  22 
self-sufficiency  of,  42,  60 

Organotherapy,  rise  of,  18 

Osmosis,  in  bodv,  37,  45 

Osteopathy,  boundaries  of,  20 

relation  of  other  systems  to,164, 

Ova,  in  relation  to  protoplasmic  con- 
tinuity, 29 

Ovary,  disorders  of  from  lesions,  334 

Overgrowth,  as  lesion,  77 

Oxidation,  in  heat  production,  47 

Oxygen,  action  of  In  body,  40 
amount  consumed,  47 
discovery  of,  13, 16 


Pain,  abnormal  condition,  65 

cause  of,  79 

definition  of,  112 

direct,  112 

inhibition  for,  148, 151,  153,  169 

morphine  for,  148 

referred,  113 

symmetrical,  82 

symptom  of,  101, 106 

transferred,  82 
Palpation,  106 
Palpitation,  82 
Pancreas,  104,  319? 
Paracelsus,  philosophy  of,  14 
Paralysis,  agitans,  92 

Bell's,  254 

caused  by  pressure,  70 
Parturition,  coccyx  in  relation  to,  352 

flooding  after,  151 

wedge  principle  in,  37 
Pascal,  law  of,  37 
Pasteur,  on  fermentation,  17 

on  germ  theory,  94 
Pathology,   Vlrchow's  influence 

on,  16,  27 

Pelvis,  338,  339,  346 
Pepsin,  action  on  proteids,  40 
Percussion,  107 
Peristalsis,  anti,  61 


INDEX. 


363 


changed,  148 

wedge  principle  in,87 
Peritonitis,  posture  in,  136 
Persians,  on  massage,  182 
Perspiration,  79 
Petrissage,  184 
Pfluger,  114,  221 
Phagocytosis,  in  infection,  31,  62 

Sternberg  and  Metchnikoff  on,  9> 
Philosophy,  of  life,  11 
Phototherapy,  176 
Phrenic  Nerve,  inhibition  of,  142,  144 

relations  of,  234,  253 

relation  to  vomiting,  61 
Physiology,  application  of  facts  of,  22 

chemical  facts  of,  40 

of  cell,  28 
Pilo-motors,  223 
Plato,  13 
Pleuritis,  cause  of.  316,  331 

friction  sounds  in,  108 

from  intercostals,  310 
Plexus,  aortic,  314 

brachial,  229.  253,  309,  314 

cardiac,  208,  313 

cervical,  26S 

hypogastric,  208,  326 

lumbar,  310 

mammary,  263 

Meissner's  and  Auerbach's,  321 

ovarian.  324 

pelvic.  208.  353 

pulmonary,  208,  315 

sacral,  311,  35'2 

solar,  151,  2C8 

subclavian.  263 

tympanic.  2H2 

vertebral,  263 
Pneuma,  theory,  13,  16 
Pncumogastric,  function  of,  143 

lesion  of,  336 

stimulation  of,  142.  187 
Pneumonia,  bacillus  of  in  normal,  96 

respiration  in,  103 

Postmortems,  in  time  of  Ptolemies,  12 
Posture,  as  cause  of  lesions,  85 

in  examination,  226,  282 

in  treatment,  242 
Potts'  Disease,  110,201 
Practice,  versus  principles,  10 
Predisposition,  as  cause  of  disease.  91 

from  perverted  structure,  75 

removal  of  as  prophylaxis,  121 
Pregnancy,  acting  as  lesion,  78 

disorder  of,  355 
Pressure,  air  in  body  function,  37,45 

as  diagnostic  measure,  10ft 

as  fundamental  in  lesion,  76 

blood,  61 

effects  from  lesions  by  direct,  77, 

246,  308,  328.  351 

effect  of  sub-occipital,  229 

on  nerves,  336 

on  vessels,  78,  332 

massage,  185 

negative,  185 

stimulant  action  of,  31, 142 

treatment  by,  128,  132,  153,  240 
Priestly,  discovery  of  oxygen  by,  13,  16 
Principles,     at   basia    of  tendency  to 

normal,  67 


in  psychotherapy,  180 
vs  practice,  10 

Problem,  of  physiology,  28 

Prophylaxis,  a  part  of  medicine,  21 
definition.  121 
in  removal  of  lesion,  123 

Prostate,  disorder  of,  365 
treatment  of,  186 

Proteid,  nature  and  value  of,  54 

Protoplasm,  chemical  and  vital  pro- 
perties of,  24,  38 
healing  power  inherent  in,  63 
parts  of  cell  a  specialization  of,28 
physical  basis  of  life,  25 

Psychotherapy,  effects  from,  175 
forms  of,  179 
principle  in,  180 

Ptolemies.medical  practice  in  time  of,12 

Ptosis,  of  abdomen,  327,  330 

Pulley,  in  body,  37 

Pulse,  Chinese  on,  12 

Trail be-Herring  curves  Independ- 
ent of,  30 

Pupillo-dilators,  212,  223,  261,  312 

Q 

Quain.  250 

on  nerves  of  ureters.  325 

on  pneumogastric,  256 

on  sacrum,  346 

on  sympathetic  to  pia,  214 
Quinine,  habit,  170 

R 

Race,  as  predisposition,  92 
Rachitis,  chest  in,  2s6 
Radiation,  of  nerve  impulses.  86,  221 
Reaction  equal  to  action,  148 

from  drug,  166 

of  degeneration,  174 
Recoil,  benefit  of  in   treatment,  128,  135 

of  function.  146 
Rectum,  atony  of,  179 

examination  per,  350 

stmulation  of,  142 
Reflex,  stimulation  through,  144,  188 

vaso-motor.  215 
Region,  cervical,  202 

coccygeal.  203 

interscapular,  266 

lumbar.  203 

pelvic,  203 

suboccipital,  229 

thoracic.  203,  2«6 
Relaxation,  by  approximation,  135 

by  pressure,  132 

by  removal  of  cause,  131 

by  stretching,  134 

for  diagnosis,  129 

methods  of,  131 

preliminary.  130 

primary,  131 

purposes,  129 
Repair,  after  abuse,  36 
Resistance,  lowered,  to  stimuli,  34 

peripheral,  147 
Respiration, example  of  self-sufficiency, 

60,  103 

stimulus  to.  88 

tract,  155, 257,  262 


364 


PRINCIPLES   OF   OSTEOPATHY. 


Revival  of  Learning,  14 
Revolution,  osteopathy  a.,  12,  18 

Rheumatism,  salicylates  for,  1G7 
Ribs,  282 

adjustment  of.  296 

articulations  of,  287 

depressed,  'J89 

first,  291,  :!0' 

floating.  2«2,  301 

lesions  of  289 

mobility  of, 293 

presssure  from.  828,  332,  336 

Kindle,  2Sfi 

8peoi.il,  291 

subluxations,  effects  from,  332 

twisted,  290 

Robinson.  Byron,  on  reflex,  83 
Rd-ntgen  Rax-,  value  of.  176 
Romans,  on  mechanotherapy,  182 
Rotation,  axes  of,  in  ribs,  287 

axes  of  in  innoininatum,  339.  842 

n.8  diagnostic  measure,  108,  23i 

In  treatment,  128,  240 

s 

Sacrum,  lesions  of,  345 
Salicylic  Acid,  in  rheumatism,  167 
Salts,  functron  of  in  body,  54 
Sanitation.  Hebrews  on,  13 

measures.  123 

Scapula,  diagnosis  and  treatment,  306 
Schiff,  «n  function  of  vagus,  143 
Schleidan  and  Scliwann,  on  cell  struc- 
ture, 27 
Schools,  during  middle  ages,  14 

iatrochemical  and  mechanical,  15 
.Sciatica,  cause  of,  69,  3 '2.  352 

inhibition  for,  142.  188 
Science,  definition  of,  20 

osteopathy  a,  21 
Sclerosis,  treatment  of,  138 
Season,  as  predisposition,  92 
Sebum,  value  of.  178 
Secreton,  disorders  of  from  lesion,  224, 

319,  3  8 

mammary.  335,  337 

relation  to  organotherapy,  18 

relation    to    protoplasmic    con- 
tinuity, 31 

Sedative,  drug  as,  16fi 
Segmental.      arrangement    of    vaso- 

motors,  218 

structures,  114 

Selection,  attribute  ofliving  tissue,  55 
Self-regulation,  by  substitution,  62 

in  disease,  61 

limits  of,  69 

of  function  and  structure,  22,  27, 

60  62,  157 

Self-sufficiency,  of  organism.  60 
Sensory  Change,  in  diagnosis.  111 
Separations, as  lesions,  198,  276 
Serotherapy,  rise  of,  18 
Serums,  Ifi7 

Sex,  as  predisposition.  92 
Sinus  V7enosus,contraction  wave  from, 

29 

Skin,  secretion  of,  178 
Smallpox,  immunity  from.  97 
Soda,  in  sour  stomach,  167 


Sounds,  in  manipulation,  201 
Specifics,  search  for,  173 
Spencer,  on  definition  of  life,  *>4 
Spinal  Cord,  effects  of  lesions   on,  246, 

264 
Spine,  approximations  in,  198 

contour  of,  1»4 

general  survey, 191 

lax.  196,274 

of  ilium,  34> 

rigid,  119,  138,  195 

straight   U5 

Spleen,  vaso-motors  of.  216,  319 
Starvation,  effect  on  organs,  62 
Sternberg,  on  phagocytosis  97 
Sternum,  examination  and  treatment 

3- 2 
Still,  on  buzzards,  95 

on  cause  of  disease,  18 

on  convulsions,  F2,  102 

on  diaphrairm.  335 

on  drainage  of  kidney,  48 

on  electric  energy.  49 

on  frequency  of  treatment,  160 

on  goitre,  2>1 

on  length  of  treatment,  161 

on  lesions  of  pelvis,  346 

on  life,  23 

on  lymph.  333 

on  plan  and  specification,  10 

on  prominences.  '200 

on  pro  to  i>l  a  sin,  25 

on  relaxation,  130 

on  sounds  in  manipulation.  201 

on  temperature  in  croup.  120 

on  youth  of  osteopath  v,  9 

revolution  inaugurated  by,  12.  19 
Stimulation,  140,  192 

after  removal  of  lesion,  150 

artificial,   142 

by  drlijrs,  166 

by  electricity,  174 

by  water,  177 

definition,  141 

intural,  141 

ostfopathic.  142,  146,  155 

possible  use  for,  141 
Stimuli,  causing  contracture,  131 

changes  constitute,  24,81 

electric.  145 

intensity  of,  145 

lesions  as,  145 

mechanical  energy  as,  46 

on  protoplasm,  34 

quick  movement  as,  161 

response  to.  13 1 

strength  and  abruptness  of,  81 

summation  of,  81 
Stomach,  condition  in  drug  user,  169 

disorders  of,  318.  331 

in  vomiting,  147 

secondary  lesion  from,  26 

skin  areas  in  connection  with, 115 

soda  for,  167 

treatment  of,  15S 

vaso-motors  of,  318 
Strabismus,  261 
Structure,  adjustment  of,  62 

cell  life  affected  by.  35 

change  of  from  psychic  disorder, 

180 


INDEX. 


365 


maintains  disorder.  72,  193 

relation  to  function,  18,  22,  25,   145 
Strychnine,  166 
Subluxation,  anterior  spinal,  277,  279 

cause  of  rib.  291 
'definition  of,  76 

diagnosis  of  spinal,  198 

of  ilium,  340 

of  ribs,  289 
Substitution,  drugs  for,  167 

in  treatment.  192 
Summation,  of  causes.  Booth  on,  94 

of  stimuli,  81 

Superior  Opening,  of  thorax.  332,  336 
Surgery,  electricity  in,  174 

Rcjentgen  ray  in,  176 

similarity  to  osteopathy.  17 
Swedish  Movement,  16,  181,  183 
Sydenhain,  on   healing  power  of  na- 
ture, 16,  18 
Sylvius,      founder      of    latrochemical 

school,  15 
Symptom,  definition  of,  105 

disad  vantageous.  105 

Hippocrates  on,  13 

in  judgment  of  normal,  64 

nature  of,  1'  1 

treatment  of.  151,  191 

varieties.  105 
Sympathetic  System,  206 

associated  with  spinal  nerves.264 

cervical,  258 

connection  with  central  system, 

208 

connection  with  cervical  nerves. 

261 

development  of.  206 

function  of  fibres  of.  212.  223 

ganglia  ted  cords  of,  207 

parts  affected  by  lesion,  213 

plexuses,  207 

thoracic.  H12 

types  of  fibres  of.  209 
Syncytium,  bmly  a,30 
Systems,  comparisons  with  other.  164 

T 

Tapotement.  184 

Temperament,  as  predispostion,  92 

Temperature,  as  cause  of  lesion,  85 

as  evidence  of  lesion,  119 

as  symptom,  101 

differences  in  cervical  lesions,   229 

in  rib  lesions,  291 

of  hand  in  treatment,  136 

treatment  of  high,  152 
Tendency  to  Normal,  64.  124.  145,  180 
Tenderness,  associated  with  Inngs,  314 

as  symptom,  106  II*-',  188,  200 

in  relation  to  ribs,  290 
Tension  of  Tissues,  in  self-adjustment, 

124 
Theorv.  germ,  15 

H art's.  222 

inhibition,  149 

of  Basch.  322 

pneuma,  13 

Therapeutics,  definition,  121 
Thermotaxis,  an  illustration   of    self- 
regulation,  61 


Thompson,  on  uses  of  salts,  54 
Thoracic  Duct,  lesions  affecting,  333 
Throat,  diseases  of  from  lesion, 245. 248 

structures  associated  with,  231 
Tobacco,  habit,  170 
Tonsillitis  massage  in,  186 
Tonsils,  232,245 
Toothache,  treatment  of,  187 
Torsion,  as  lesion,  198,  203,  27»> 
Torticollis,  106,  109 
Touch,  necessity  for  delicate  sense  of, 

107 
Toxins,  in  metabolism,  33 

from  bacteria,  95 
Traube-Herring  curves,  30 
Treatment,  curative  versus  palliative, 

125 

frequency  of,  160 

habit.  149   185 

internal  3il 

length  of,  161 

natural  methods  of,  191 

negative.  155 

of  clavicle.  305 

of  connective  tissue  lesions,  138 

of  disease,  121,  155 

ef  flat  spine,  268 

of  other  lesions,  137 

of  scapula,  307 

of  sternum  and  cartilages,  803 

of  symptoms.  151 

of  temperature,  152 

of  pelvis.  346 

possibility  of  harm  in.  161 

rapidity  of  movement  in,  161 

to  force  obstruction,  151 

tonic,  1«9,  150 

Trvp*in,  action  on  proteids,  40 
Tuberculosis,  92  284,  329 
Tumor,  as  lesion,  78 

treatment  of.  137 

u 

Unit,  morphological.  30 

nature  a,   14 
Urea,  formation  of,  40 
Ureter,  nerves  of,  325 
Urinnlysis,  by  Brahmins,  12 
Urinary  Apparatus,  location  of,  45 
Urine,  incontinence  of.  326 

retenti  m  of.  355 
Uterus,  displacement  of,  338 

flooding  from,  151 

lesions  affecting,  324,  354 


Vagus,  congh  from  irritation  to,  233 

functions  of,  143 

influence  in  vomiting.  61 

inhibition  influence  on  heart.  141 
VanHelmont,  15 
Vaso-motors,  action  of.  216 

associated  with   fifth.  254 

associated  with  ninth,  256 

definition  of,  214 

lesions  affecting,  216 

of  bladder,  427,  354 

of  limbs,  328 

of  liver,  pancreivs  and  spleen.  319 


366 


PRINCIPLES   OF   OSTEOPATHY. 


of  ovary  and  uterus,  824 

of  sympathetic,  212 

reflex  mechanism  of,  214 

system,  214 

varieties  of,  214 
Vein,  inferior  thyroid,  7S,  261 

intervertebral.  204,  250,  308 

jugular,  187,233 

portal,  78 

pressure  on,  78 

KaphenouK,  353 

varicose,  78,353 

vertebral,  249 

vena  caya,  336 
Vertebra?,  adjustment  of,  240 

cervical,  234 

examination  and  treatment,   197, 

199.  234.  238,  277,  279 

lumbar,  277 

relation  of  ribs  to,  282,  296 

thoracic,  26« 
Verworn,  on  electrotherapy,  175 

on  formula  for  protelds,  39 

on  lagrippe,  33 

Vibration,  in  massage,  185,  187 
Viewpoint,  of  life,  22 
Virchow,  on  cell  patholojry,  16,  27,  32 
Viscero-motors,  212,  223,  319,  322 
Vital  Force,  beyond  physics,  23,63,59,68 


Haller  on,  16 

In  nerve  action,  221 

Vital  Level,  180 

Vomiting,  as  example    of    self-regula- 
tion, 61,  108 
of  pregnancy ,84 
treatment  for,  152 
wedge  action  In,  37 

w 

Water,  as  sedative,  178 

as  stimulant.  177 

as  thermal  agent,  177 

importance  of  In  body,  39,  54 
Wedge,  action  of  in  body,  '37 

action  of  sacrum,  347 
Wilson,  on  life,  23 

X 

X-Rays,  burns  from,  48 


Ziegenspeck,   on    treatment  of  adhe- 
sions, 187 
on  treatment  of  uterus, 187 


University  of  California 

SOUTHERN  REGIONAL  LIBRARY  FACILITY 

405  Hilgard  Avenue,  Los  Angeles,  CA  90024-1388 

Return  this  material  to  the  library 

from  which  it  was  borrowed. 


CAT.    NO.    24    I6l 


A     000510224     9 


UC   RV  NE  LIBRARY 


3  1970016237874 


Hulett,  Guy  D. 
Text  took  of 
osteopathy 


1903 
principles 


of 


WB9UO 
H912t 
1903 

Hulett,  Gj>y  D. 

Text  book  of  the  principles  of 

osteopathy 


MEDICAL  SCIENCES  LIBRARY 

UNIVERSITY  OF  CALIFORNIA,  IRVINE 

IRVINE,  CALIFORNIA  92664 


